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Despite a wealth of clinical studies and publications focused on the cause and prevention of contrast-induced nephropathy (CIN), there remain conflicting opinions regarding the relative risks for CIN for iso-osmolar and certain low-osmolar contrast media (CM) in subjects with pre-existing renal impairment. We aimed to compare the incidence of CIN (as defined by a postdose SCr increase of ≥ 0.5 mg/dl or an increase of ≥ 25% from baseline) in subjects with renal impairment (eGFR 20-59 mL/min) undergoing coronary angiography and/or intervention.
462 patients enrolled into one of three prospective studies (CARE and 2 unpublished studies) who were randomized to receive either iodixanol-320 (n=236) or iopamidol-370 (n=226) were evaluated. SCr was measured at baseline and 2-5 days post-angiography. CIN incidence was determined for i) patients with moderate renal impairment (baseline eGFR > 30 and <60 mL/min/1.73 m2; iodixanol n = 213, iopamidol = 206 and ii) patients with severe renal impairment eGFR ≤30 mL/min/1.73 m2 (iodixanol n= 23; iopamidol = 20). Differences in demographics, baseline characteristics, and CIN rate were compared using Fisher’s exact test for categorical data and Students t-test for numeric variables. The odds ratio and 95% predict interval were from a Bayesian logistical regression model.
There were no significant differences in baseline characteristics, including the proportion of diabetics, between cohorts. There were no statistically significant differences in CIN risk or odds ratio between iodixanol and iopamidol (see below table).
|Study Population||Iodixanol 320mg||Iopamidol 370mg||p-value||Odds Ratio (95% Predict Interval)|
|SCr increase from baseline ≥ 0.5 mg/dL|
|eGFR≤30||4/23 (17.4%)||3/20 (15.0%)||1.000||1.2 (0.2, 6.8)|
|30<eGFR<60||11/213 (5.2%)||7/206 (3.4%)||0.472||1.6 (0.6, 4.6)|
|SCr increase from baseline ≥ 25%|
|eGFR≤30||3/23 (13.0%)||1/20 (5.0%)||0.611||3.5 (0.3, 50.0)|
|30<eGFR<60||24/213 (11.3%)||21/206 (10.2%)||0.754||1.1 (0.6, 2.1)|
There is no difference in the risk of CIN after iodixanol-320 and iopamidol-370 in patients with moderate to severe renal impairment undergoing coronary angiography/PCI.
OTHER: Renal Insufficiency and Contrast Nephropathy