A discussion of a study titled, "Nephrotoxicity of iodixanol versus iopamidol in patients with chronic kidney disease and diabetes
mellitus undergoing coronary angiographic procedures'" which was published in the November 2009 issue of the American heart Journal (Am Heart J 2009;158:822-828.e3)
Authors: Warren Laskey, MD,a Peter Aspelin, MD,b Charles Davidson, MD,c Michael Rudnick, MD,d Pierre Aubry, MD,e
Sreenivas Kumar, MD,f Frank Gietzen, MD,g and Marcus Wiemer, MDh on behalf of the DXV405 Study Group
Albuquerque, MN; Stockholm, Sweden; Chicago, IL; Philadelphia, PA; Paris, France; Andhra Pradesh, India; and
Saale and Bad Oyenhausen, Germany
Abstract: Background The choice of radiographic contrast media for use in patients at increased risk of contrast-induced
nephropathy (CIN) is of ongoing interest.
Methods The current study is a prospective, multicenter, randomized, double-blind design comparing the renal effects of
the non-ionic, iso-osmolal agent, iodixanol, versus the non-ionic, low-osmolal agent, iopamidol, in 526 subjects with impaired
baseline renal function (chronic kidney disease) and diabetes mellitus undergoing diagnostic and/or therapeutic coronary
angiographic procedures. The co-primary end points were the peak increase in serum creatinine (SCr) and the incidence of
CIN (increase ≥0.5 mg/dL) in SCr from baseline within 3 days of receiving contrast media.
Results In 418 evaluable subjects with complete postcontrast media SCr data, the median peak increase in SCr in the
iodixanol arm was 0.10 mg/dL, whereas in the iopamidol arm, the median peak increase was 0.09 mg/dL (P = .13). The
overall CIN incidence was 10.5% (11.2% % in the iodixanol arm and 9.8% in the iopamidol arm, P = .7). The volume of
contrast media, volume of saline administered, frequency of coronary interventional procedures, and severity of baseline
kidney disease and of diabetes mellitus were similar between treatments.
Conclusions In the present study, the overall rate of CIN in patients with chronic kidney disease and DM undergoing
coronary angiographic procedures was 10.5%. There was no significant difference between iodixanol and iopamidol in either
peak increase in SCr or risk of CIN. (Am Heart J 2009;158:822-828.e3.)
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