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Ioxaglate Versus IoDixanol for the Prevention of Contrast-Induced Nephropathy: The IDPC Trial
Rafaela Andrade Penalva Freitas, Luis Fernando Tanajura, Roxana Mehran
1Instituto Dante Pazzanese de Cardiologia, Av. Dr Dante Pazzaensse, 500, Ibirapuera, São Paulo - SP, Brazil. rmvcosta@uol.com.br.
Insights
Low- and iso-osmolar iodine contrast agents showed similar rates of contrast-induced nephropathy (CIN) in high-risk patients undergoing percutaneous coronary procedures. The choice of contrast agent did not impact CIN incidence, dialysis, or mortality rates.
Area of Science:
- Cardiology
- Nephrology
- Radiology
Background:
- Percutaneous coronary procedures offer benefits but risk contrast-induced nephropathy (CIN) with iodine contrast agents.
- CIN can increase the risk of dialysis and major adverse cardiac events (MACE).
Purpose of the Study:
- To compare low-osmolar versus iso-osmolar iodine contrast agents for CIN prevention in high-risk patients.
- To evaluate the impact of contrast agent type on CIN incidence and clinical outcomes.
Main Methods:
- A single-center, randomized (1:1) trial involving 2,268 high-risk patients undergoing percutaneous coronary procedures.
- High-risk criteria included age >70, diabetes, chronic kidney disease, heart failure, cardiogenic shock, or acute coronary syndrome (ACS).
- Primary endpoint: CIN occurrence (defined by creatinine increase) between day 2-5 post-procedure. Low (ioxaglate) vs. iso-osmolar (iodixanol) contrast was used.
Main Results:
- Overall CIN incidence was 15%, with no significant difference between iso-osmolar (15.2%) and low-osmolar (15.1%) contrast groups (P>.99).
- No significant differences in CIN were observed in subgroups like diabetics, elderly, or ACS patients.
- Thirty-day follow-up showed similar rates of dialysis (13 vs. 11 patients) and mortality (3.3% vs. 2.6%) between groups.
Conclusions:
- In high-risk patients undergoing percutaneous coronary procedures, the incidence of CIN is approximately 15%.
- The type of iodine contrast agent used (low- vs. iso-osmolar) did not influence CIN rates.
- Contrast agent choice appears not to affect CIN risk or subsequent clinical outcomes in this high-risk population.
Background:
Despite the potential benefits of percutaneous procedures for the assessment and treatment of coronary artery disease, these interventions require the use of iodine contrast, which might lead to contrast-induced nephropathy (CIN) and increased risk of dialysis and major adverse cardiac events (MACE).
Aims:
We sought to compare two different iodine contrasts (low vs. iso-osmolar) for the prevention of CIN among high-risk patients.
Methods:
This is a single-center, randomized (1:1) trial comparing consecutive patients at high risk for CIN referred to percutaneous coronary diagnostic and/or therapeutic procedures with low (ioxaglate) vs. iso-osmolarity (iodixanol) iodine contrast. High risk was defined by the presence of at least one of the following conditions: age >70 years, diabetes mellitus, non-dialytic chronic kidney disease, chronic heart failure, cardiogenic shock, and acute coronary syndrome (ACS). The primary endpoint was the occurrence of CIN, defined as a >25% relative increase and/or >0.5 mg/dL absolute increase in creatinine (Cr) levels compared with baseline between the 2nd and 5th day after contrast media administration.
Results:
A total of 2,268 patients were enrolled. Mean age was 67 years. Diabetes mellitus (53%), non-dialytic chronic kidney disease (31%), and ACS (39%) were highly prevalent. The mean volume of contrast media was 89 ml ± 48.6. CIN occurred in 15% of all patients, with no significant difference regarding the type of contrast used (iso = 15.2% vs. low = 15.1%, P>.99). Differences were not observed in specific subgroups such as diabetics, elderly, and ACS patients. At 30-day follow-up, 13 patients in the iso-osmolarity group and 11 in low-osmolarity group required dialysis (P =.8). There were 37 (3.3%) deaths in the iso-osmolarity cohort vs. 29 (2.6%) in the low-osmolarity group (P =.4).
Conclusion:
Among patients at high risk for CIN, the incidence of this complication was 15%, and independent of the use of low- or iso-osmolar contrast.
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