High-dose clinical urography with the low-osmolality contrast agent Hexabrix: comparison with a conventional contrast agent.

Abstract

A double-blind clinical trial was performed in 60 patients to compare Hexabrix (ioxaglate meglumine and ioxaglate sodium) and Renografin-60 (diatrizoate meglumine and diatrizoate sodium). Use of Hexabrix produced higher urinary iodine concentrations, lower urine volumes at 30 minutes, and excretory urograms significantly better in diagnostic quality, as rated by four independent observers. There was no difference in nephrogram quality between contrast agents. Patients receiving Hexabrix had less of an increase in heart rate and demonstrated a slight rise in mean arterial blood pressure, rather than the biphasic rise then fall seen with Renografin-60. There was no significant change for up to 96 hours after urography in results of hematology, clinical chemistry, or urinalysis, except for an increase of 0.005 in urine specific gravity with Renografin-60. Patients reported significantly less body heat, heat in the injection arm, and overall discomfort with Hexabrix. There was a similar amount of nausea and vomiting in the two groups. Hexabrix also caused histaminic-type reactions in three patients.

Effects of non-ionic iodinated contrast media on patient heart rate and pressures during intra-cardiac or intra-arterial injection

“…Whereas previous studies have shown that ionic iodinated CM have greater effects on hemodynamic parameters than non-ionic iodinated CM [2,4], and that high osmolar CM exert greater effects than low osmolar CM [1], no consistent, clinically relevant differential effects have been noted between the iso-osmolar iodinated CM iodixanol and the low osmolar iodinated CM iohexol [7,8,10]. The results of the present study support the view that hemodynamic parameters are affected negligibly and equally by isoosmolar and low osmolar CM alike, and that no other significant differential effects between these categories of CM are discernable.…”

“…Iodinated contrast media (CM) are known to have transient vasodilatory properties which can influence hemodynamic and International Journal of Cardiology 118 (2007) 389 -396 www.elsevier.com/locate/ijcard electrocardiographic (ECG) parameters immediately after administration [1][2][3][4][5][6][7][8][9][10][11]. While the reported changes in heart rate (HR) and left ventricular (LV) pressure or arterial blood pressure (BP) are generally considered clinically insignificant and do not cause problems in terms of patient safety, variations in HR in particular might conceivably impact on diagnostic image quality of scans that require cardiac gating.…”

Current iodinated contrast media

“…Moreover, in comparison with nonionic monomers the injection of ioxaglate is followed by a higher frequency of some minor reactions, namely nausea and vomiting [14,44]. These phenomena occur with a frequency similar to that following diatrizoate administration [13].…”