Renal toxicity evaluation and comparison between visipaque (iodixanol) and hexabrix (ioxaglate) in patients with renal insufficiency undergoing coronary angiography - The RECOVER study: A randomized controlled trial

被引:236
作者
Jo, Sang-Ho
Youn, Tae-Jin
Koo, Bon-Kwon
Park, Jim-Shik
Kang, Hyun-Jae
Cho, Young-Seok
Chung, Woo-Young
Joo, Gwon-Wook
Chae, In-Ho
Choi, Dong-Ju
Oh, Byung-Hee
Lee, Myoung-Mook
Park, Young-Bae
Kim, Hyo-Soo
机构
[1] Seoul Natl Univ, Coll Med, Ctr Cardiovasc, Seoul Natl Univ Hosp,Div Cardiol, Seoul, South Korea
[2] Seoul Natl Univ, Coll Med, Ctr Cardiovasc, Seoul Natl Univ Hosp,Div Nephrol,Dept Internal Me, Seoul, South Korea
[3] Dongguk Univ Int Hosp, Ctr Cardiovasc, Goyang, Gyeonggi Do, South Korea
关键词
D O I
10.1016/j.jacc.2006.06.047
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES This study sought to compare the nephrotoxicity of iodixanol and ioxaglate in patients with renal impairment undergoing coronary angiography. BACKGROUND lodixanol, a nonionic, dimeric, iso-osmolar contrast medium (IOCM), may be less nephrotoxic than low-osmolar contrast media (LOCM) in high-risk patients. METHODS In a prospective, randomized trial in 300 adults with creatinine clearance (CrCI) <= 60 ml/min, patients received either iodixanol or ioxaglate and underwent coronary angiography with or without percutaneous coronary intervention. The primary end point was the incidence of contrast-induced nephropathy (CIN) (an increase in serum creatinine [SCr] >= 25% or >= 0.5 mg/dl [>= 44.2 mu mol/1]). The incidence of CIN in patients with severe renal impairment at baseline (CrCI < 30 ml/min) or diabetes and in those receiving large doses (>= 140 ml) of contrast medium was also determined. RESULTS The incidence of CIN was significantly lower with iodixanol (7.9%) than with ioxaglate (17.0%; p = 0.021), corresponding to an odds ratio (OR) of CIN of 0.415 (95% confidence interval [CI] 0.194 to 0.889) for iodixanol. The incidence of CIN was also significantly lower with iodixanol in patients with severe renal impairment (p = 0.023) or concomitant diabetes (p = 0.041), or in patients given >= 140 ml of contrast media (p = 0.038). Multivariate analysis identified use of ioxaglate (OR 2.65, 95% CI 1.11 to 6.33, p = 0.028), baseline SCr, mg/dl (OR 2.0, 95% CI 1.04 to 3.85, p 0.038), and left ventricular ejection fraction, % (OR 0.97, 95% CI 0.94 to 0.99, p = 0.019) as independent risk factors for CIN. CONCLUSIONS The IOCM iodixanol was significantly less nephrotoxic than ioxaglate, an ionic, dimeric LOCM.
引用
收藏
页码:924 / 930
页数:7
相关论文
共 30 条
  • [1] Nephrotoxic effects in high-risk patients undergoing angiography.
    Aspelin, P
    Aubry, P
    Fransson, S
    Strasser, R
    Willenbrock, R
    Berg, KJ
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2003, 348 (06) : 491 - 499
  • [2] Cost-effectiveness of iodixanol in patients at high risk of contrast-induced nephropathy
    Aspelin, P
    Aubry, P
    Fransson, SG
    Strasser, R
    Willenbrock, R
    Lundkvist, J
    [J]. AMERICAN HEART JOURNAL, 2005, 149 (02) : 298 - 303
  • [3] A rapid protocol for the prevention of contrast - Induced renal dysfunction: the RAPPID study
    Baker, CSR
    Wragg, A
    Kumar, S
    De Palma, R
    Baker, LRI
    Knight, CJ
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 41 (12) : 2114 - 2118
  • [4] METAANALYSIS OF THE RELATIVE NEPHROTOXICITY OF HIGH-OSMOLALITY AND LOW-OSMOLALITY IODINATED CONTRAST-MEDIA
    BARRETT, BJ
    CARLISLE, EJ
    [J]. RADIOLOGY, 1993, 188 (01) : 171 - 178
  • [5] INVITRO STUDY OF THE INHIBITION OF COAGULATION INDUCED BY DIFFERENT RADIOCONTRAST MOLECULES
    BELLEVILLE, J
    BAGUET, J
    PAUL, J
    CLENDINNEN, G
    ELOY, R
    [J]. THROMBOSIS RESEARCH, 1985, 38 (02) : 149 - 162
  • [6] Influence of a nonionic, iso-osmolar contrast medium (iodixanol) versus an ionic, low-osmolar contrast medium (ioxaglate) on major adverse cardiac events in patients undergoing percutaneous transluminal coronary angioplasty a multicenter, randomized, double-blind study
    Bertrand, ME
    Esplugas, E
    Piessens, J
    Rasch, W
    [J]. CIRCULATION, 2000, 101 (02) : 131 - 136
  • [7] Acetylcysteine for prevention of contrast nephropathy:: meta-analysis
    Birck, R
    Krzossok, S
    Markowetz, F
    Schnülle, P
    van der Woude, FJ
    Braun, C
    [J]. LANCET, 2003, 362 (9384) : 598 - 603
  • [8] Acetylcysteine and contrast agent-associated nephrotoxicity
    Briguori, C
    Manganelli, F
    Scarpato, P
    Elia, PP
    Golia, B
    Riviezzo, G
    Lepore, S
    Librera, M
    Villari, B
    Colombo, A
    Ricciardelli, B
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 40 (02) : 298 - 303
  • [9] Comparison of iodixanol and iohexol in renal impairment
    Chalmers, N
    Jackson, RW
    [J]. BRITISH JOURNAL OF RADIOLOGY, 1999, 72 (859) : 701 - 703
  • [10] PREDICTION OF CREATININE CLEARANCE FROM SERUM CREATININE
    COCKCROFT, DW
    GAULT, MH
    [J]. NEPHRON, 1976, 16 (01) : 31 - 41