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Renal failure in 57 925 patients undergoing coronary procedures using iso-osmolar or low-osmolar contrast media

P Liss1, P B Persson, P Hansell

  • 1Institute of Radiology, University of Uppsala, Uppsala, Sweden.

Kidney International
|September 28, 2006
PubMed

Insights

Contrast media (CM) use in patients undergoing coronary procedures was evaluated. Iodixanol (iso-osmolar) was linked to higher rates of contrast media-induced renal failure and dialysis compared to ioxaglate or iohexol (low osmolar).

Area of Science:

  • Nephrology
  • Cardiology
  • Radiology

Background:

  • Contrast media (CM) are widely used in cardiac procedures.
  • Renal failure is a significant complication following these procedures.
  • Different types of CM may carry varying risks for renal injury.

Purpose of the Study:

  • To compare the incidence of contrast media-induced renal failure after coronary angiography and angioplasty.
  • To evaluate the risk associated with different types of CM: iodixanol (iso-osmolar), ioxaglate (low osmolar), and iohexol (low osmolar).

Main Methods:

  • Retrospective analysis using Swedish Coronary Angiography and Angioplasty Registry and Swedish Hospital Discharge Register.
  • Comparison of renal failure incidence in patients receiving iodixanol, ioxaglate, or iohexol between 1990 and 2003.
  • Analysis of risk in diabetic patients and those with prior renal failure.

Main Results:

  • Clinically significant renal failure occurred in 1.7% of patients receiving iodixanol versus 0.8% for ioxaglate (P<0.001).
  • Odds ratio for renal failure was significantly higher for iodixanol compared to ioxaglate (1 vs 0.48, P<0.001).
  • Dialysis rates were higher with iodixanol (0.2%) than ioxaglate (0.1%). Iohexol showed a similar low risk to ioxaglate.

Conclusions:

  • The risk of contrast media-induced renal failure and need for dialysis after coronary procedures is higher with iodixanol compared to ioxaglate or iohexol.
  • Iodixanol is associated with increased renal risk, particularly in vulnerable patient subsets.
  • Low osmolar contrast media like ioxaglate and iohexol appear safer regarding renal outcomes.

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