Contrast-induced acute kidney injury in patients with renal dysfunction undergoing a coronary procedure and receiving non-ionic low-osmolar versus iso-osmolar contrast media

Elias Alexopoulos, Konstantinos Spargias, Stamatis Kyrzopoulos, Athanassios Manginas, Gregory Pavlides, Vassilis Voudris, Stamatios Lerakis, Dalton S. McLean, Dennis V. Cokkinos

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

Background: Although the superiority of low-osmolar over high-osmolar contrast agents in prevention of contrast-induced acute kidney injury (CI-AKI) is generally accepted, the relative nephrotoxicity of iso-osmolar over low-osmolar agents has not yet clearly defined. We examined the incidence of CI-AKI according to the type of contrast agent used in a randomized study of ascorbic acid for CI-AKI prevention. Methods: A total of 222 patients with baseline serum creatinine ≥1.2 mg/dL who were undergoing a coronary procedure and who were randomized to receive ascorbic acid or placebo were evaluated. The iso-osmolar agent iodixanol was used in 144 patients, whereas low-osmolar non-ionic agents were used in 78 patients (iomeprol, n = 40; iobitridol, n = 30; iopentol, n = 8). CI-AKI was defined by an absolute serum creatinine increase of ≥0.5 mg/dL or a relative increase of ≥25% measured 2 to 5 days after the procedure. Results: The groups of patients who received iso-osmolar and low-osmolar non-ionic agents were well balanced in terms of demographic, clinical, and procedural characteristics. The overall CI-AKI incidence was 14.6% for the iso-osmolar iodixanol versus 14.1% for the combined low-osmolar non-ionic agents (iomeprol, 10%; iobitridol, 10%; iopentol, 50%). For iodixanol, the incidence of CI-AKI was 7.4% for patients randomized to receive ascorbic acid and 21.6% for placebo (P = 0.02). The corresponding incidences for the low-osmolar non-ionic agents were 9.1% and 20.6%, respectively (P = 0.19). Conclusion: No differences in CI-AKI incidence were apparent among patients receiving non-ionic iso-osmolar iodixanol and non-ionic low-osmolar contrast agents. The preventative effect of ascorbic acid was also similar.

Original languageEnglish (US)
Pages (from-to)25-30
Number of pages6
JournalAmerican Journal of the Medical Sciences
Volume339
Issue number1
DOIs
StatePublished - Jan 2010

Keywords

  • Contrast-induced nephropathy
  • Coronary procedure
  • Iso-osmolar contrast media
  • Low-osmolar contrast media
  • Renal dysfunction

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'Contrast-induced acute kidney injury in patients with renal dysfunction undergoing a coronary procedure and receiving non-ionic low-osmolar versus iso-osmolar contrast media'. Together they form a unique fingerprint.

Cite this