Extended Renal Outcomes with Use of Iodixanol versus Iohexol after Coronary Angiography

Abstract

The impact of isoosmolar versus low-osmolar contrast media (CM) administration on contrast-induced acute kidney injury (CI-AKI) and extended renal dysfunction (ERD) is unclear. We retrospectively examined incidences of CI-AKI and ERD in patients who received iodixanol (isoosmolar) versus iohexol (low-osmolar) during angiography for cardiac indications. Of 713 patients, 560 (cohort A), 190 (cohort B), and 172 (cohort C) had serum creatinine monitored at 3 days, 30 days, and 6 months after angiography, respectively. 18% of cohort A developed CI-AKI, which was more common with iodixanol than iohexol (22% versus 13%, P = 0.006). However, patients given iodixanol were older with lower baseline estimated glomerular filtration rates (eGFR). On multivariate analysis, independent associations with higher CI-AKI risk include age >65 years, female gender, cardiac failure, ST-elevation myocardial infarction, intra-aortic balloon pump, and critical illness, but not CM type, higher CM load, or eGFR < 45 mL/min/1.73 m2. 32% of cohort B and 34% of cohort C had ERD at 30 days and 6 months, while 44% and 41% of subcohorts had ERD at 90 days and 1 year, respectively. CI-AKI, but not CM type, was associated with medium- and longer-term ERD, with 3-fold higher risk. Advanced age, emergent cardiac conditions, and critical illness are stronger predictors of CI-AKI, compared with CM-related factors. CI-AKI predicts longer-term ERD.

Incidence, risk factors, and prognosis of acute kidney injury following transarterial chemoembolization in patients with hepatocellular carcinoma: A prospective cohort study

“…[41][42][43] Low-osmolar iohexol is reported to induce a higher risk of AKI in CKD patients. [44] CM isoosmolar iodixanol is also reported to reduce the risk of contrast-induced AKI in DM or CKD patients compared with low-osmolar iohexol. [8,44] Nevertheless, findings on the apparent benefit have not been consistent; no significant advantage of iohexol over iodixanol was observed in the prevention of AKI and prolonged renal insufficiency.…”

“…[44] CM isoosmolar iodixanol is also reported to reduce the risk of contrast-induced AKI in DM or CKD patients compared with low-osmolar iohexol. [8,44] Nevertheless, findings on the apparent benefit have not been consistent; no significant advantage of iohexol over iodixanol was observed in the prevention of AKI and prolonged renal insufficiency. [45] Operators of coronary angiography may prefer to use iodixanol for radiography in high-risk subjects, hence in this present study.…”

Computed tomography and magnetic resonance imaging of thoracic chordoma in a Bengal tiger (<i>Panthera tigris tigris</i>)

“…We considered that a decrease in relative blood volume during anesthesia exacerbated the renal dysfunction and that the cause of death was renal failure. Contrast-medium-induced acute kidney injury has been reported in a dog [ 7 ] and humans [ 2 ], but renal failure connected to contrast medium is unidentified here because it was not possible to conduct extensive preanesthetic evaluation on this tiger.…”