PURPOSE: Contrast-induced nephropathy (CIN) is a common cause of hospital-acquired renal failure. It is a complex syndrome of acute renal failure occurring after the administration of contrast media and contributing to prolonged hospital stay and mortality. Iodixanol, a nonionic, dimeric, iso-osmolar contrast medium (IOCM), may be less nephrotoxic than iohexol (low-osmolar contrast media, LOCM) in high-risk patients. In this study, we sought to compare the nephrotoxicity of iodixanol (IOCM) and iohexol (LOCM) in patients with prior renal impairment undergoing coronary angiography.
METHODS: Our study population comprised of patients with underlying chronic kidney disease admitted from January 2005 to September 2010 for any cardiac catheterization (elective/emergent) procedure. The patients were divided into two study groups depending upon the type of contrast agent used during the procedure [IOCM (n=302) vs LOCM (n=150)]. The primary parameter analyzed was the incidence of CIN. Secondary parameters analyzed were demographics, cardiovascular risk factors, renal function before and after the procedure, need for dialysis and procedural specifics including the volume of contrast. CIN was defined as an absolute increase of serum creatinine by 0.5 mg/dl after the cardiac catheterization.
RESULTS: The incidence of CIN was recorded to be lower in the IOCM group, 20.53% (62/302) as opposed to 24.00% (36/150) in the LOCM group but no statistical significance could be achieved, P = 0.39. The median change in creatinine after the cardiac catheterization was calculated to be 0.25 (95% CI-0.1, 0.7) in the IOCM group versus 0.5 (95% -0.1, 1.27) in the LOCM group, P=0.51.
CONCLUSIONS: Overall, the nephrotoxicity associated with IOCM use was lower but not significantly different from that observed with LOCM use in chronic kidney disease patients undergoing coronary angiography.
CLINICAL IMPLICATIONS: In view of the high incidence of CIN, our data stress the need for the development and validation of new preventive strategies for renal protection during emergent or elective coronary angiographies.
DISCLOSURE: The following authors have nothing to disclose: Sharad Bajaj, Manish Sharma, Rupen Parikh, Shivani Patel, Nishant Gupta, Chandra Chandran, Aiman Hamdan, Fayez Shamoon, Mahesh Bikkina
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