Comparison between the efficacy of dimeric and monomeric non-ionic contrast media (iodixanol vs iopromide) in urography in patients with mild to moderate renal insufficiency.

Abstract

Non-ionic dimers induce less diuresis than non-ionic monomers, resulting in increased opacification of the urinary tract in intravenous (i.v.) urography. This double blind, comparative, randomized, parallel trial compared the efficacy of iodixanol (non-ionic dimer) and iopromide (non-ionic monomer) in 100 patients with mild to moderate renal insufficiency (serum creatinine of 135 to 265 mumol l-1) who underwent i.v. urography. A total dose of 600 mgI kg-1 bw of iodixanol (320 mgI ml-1) or iopromide (300 mgI ml-1) was injected. Radiographs were blindly evaluated by three radiologists who analysed different parameters (renal border visualization, nephrogram density, calyceal filling and density, papillary blush detection, delineation of collecting ducts, renal pelvis opacification, visualization of ureters, bladder density, bladder distention). Densitometric evaluation on the renal pelvis and bladder was also performed. Iodixanol showed better filling and density of the calyces (p = 0.004), more frequent detection of papillary blush (p = 0.003) and better opacification of the renal pelvis (p = 0.006). No significant differences between the two contrast media were found in regard to other parameters. In conclusion, the results confirmed theoretical expectations. The non-ionic dimer iodixanol is to be preferred to a non-ionic monomer such as iopromide in i.v. urography on patients with impaired renal function.

Comparison of Excretory Urographic Contrast Effects of Dimeric and Monomeric Non-Ionic Iodinated Contrast Media in Dogs

“…However, it is believed that there is no difference in excretion speed from the blood between the two contrast media because the CT value of the aorta showed a similar TDC pattern in both groups and blood iodine concentration after one hour did not show a significant difference. In addition, according to the past reports that indicate there was no significant difference in the contrast effect except in the kidney between monomeric and dimeric contrast media [2,[9][10][11], and the reports of increasing urinary volume with the use of monomeric contrast media relative to dimeric contrast media [7,10], it is considered that the remarkable difference in the contrast effect in the kidney is mainly derived from the osmotic diuresis in the renal tubules. This means that, after passing the glomerulus, the monomeric contrast media, with high osmolarity, is diluted in the renal tubules because it receives greater influence of osmotic diuresis than dimeric contrast media by reason of its high osmolarity [6].…”

“…The difference in the osmolarity of the contrast media has no significant effect on the contrast study in most organs because the changes in iodine concentration in these organs are influenced mainly by tissue blood flow. On the other hand, in the kidney, which consists of blood vessels and renal tubules, the contrast effects are influenced by the osmolarity of the media because changes in iodine concentration are influenced by both renal blood flow and excretion of iodine to tubules [2,[9][10][11].…”

Current iodinated contrast media

“…In one trial iodixanol showed better filling and density of the calyces, more frequent detection of papillary blush, and better opacification of the renal pelvis than iopromide [46].…”

Assessing Diagnostic Confidence

“…This has been utilized in a variety of studies (3)(4)(5)(6)(7)(8)(9). Some developments of this simple approach attempt to take into account changes in diagnoses that might arise as a result of the test.…”