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Comparison of iodixanol and iohexol in renal impairment
1Department of Radiology, Manchester Royal Infirmary, UK.
Insights
Iodixanol, an iso-osmolar contrast medium, showed potentially lower nephrotoxicity than iohexol in patients with renal impairment. This prospective study found a significantly lower incidence of creatinine increase with iodixanol use.
Area of Science:
- Nephrology
- Radiology
- Pharmacology
Background:
- Iodinated contrast media are essential for angiography but can pose risks to renal function.
- Iodixanol is a non-ionic, iso-osmolar dimer contrast agent.
- Limited data exist on iodixanol's renal tolerance in patients with impaired kidney function.
Purpose of the Study:
- To compare the renal tolerance of iodixanol versus iohexol in patients undergoing angiography.
- To assess if iodixanol offers superior renal safety compared to iohexol in a high-risk population.
Main Methods:
- A prospective, randomized controlled trial comparing iodixanol and iohexol.
- Serum creatinine levels were measured before and after angiography in inpatient subjects.
- Incidence of creatinine increase (>10%) within one week post-procedure was the primary outcome.
Main Results:
- 15% of patients receiving iodixanol experienced a creatinine rise compared to 31% receiving iohexol (p < 0.05).
- A positive correlation was observed between contrast media dose and creatinine increase for both agents.
- Iodixanol demonstrated a trend towards reduced nephrotoxicity compared to iohexol.
Conclusions:
- Iodixanol may be slightly less nephrotoxic than iohexol in patients with renal impairment undergoing angiography.
- Further research is warranted to confirm the nephroprotective benefits of iodixanol in this patient cohort.
Abstract:
Iodixanol (Visipaque, Nycomed, Oslo, Norway) is an iodinated contrast medium in the form of a non-ionic dimer which is iso-osmolar with plasma at all iodine concentrations. There is little evidence regarding its renal tolerance in renal impairment. We therefore undertook a prospective randomized comparison of iodixanol and the non-ionic monomer iohexol (Omnipaque, Nycomed, Oslo, Norway). The serum creatinine was measured pre- and post-angiography in a series of in-patients to establish whether there was any clinically detectable evidence of superiority of iodixanol over iohexol in this high risk group. 8/54 (15%) patients in the iodixanol group had a rise in creatinine of > 10% in the week following angiography compared with 15/48 (31%) in the iohexol group (p < 0.05). The creatinine rise was positively correlated with the dose of both contrast media. These results suggest that iodixanol may be slightly less nephrotoxic than iohexol.
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