Iodixanol versus iopromide in cancer patients: Evidence from a randomized clinical trial

Abstract

To assess the safety profile of iso-osmolar contrast medium (CM) versus low osmolar CM in cancer patients with an estimated glomerular filtration rate (eGFR) >60 ml/min. In this multicenter, blind trial of patients seeking a chest-abdomen-pelvis contrast enhanced computed tomography (CT) with iodated CM, participants were centrally randomized to iodixanol or iopromide. Contrast induced nephropathy (CIN) at 24 and/or 72 hr were our primary outcomes. We further considered irreversible CIN, average eGFR percentage variation (%Δ), and adverse events (AEs). Overall, 607 patients were enrolled. Among them, 497 eligible patients were randomized to iodixanol (N: 247) or iopromide (N: 250). No differences emerged by descriptive characteristics. Seven and 3 CIN at 24 hr (p = 0.34) and 8 and 2 CIN at 72 hr (p = 0.11) occurred in the iopromide and iodixanol group, respectively. Within the subgroup of individual patients who developed CIN (N: 17), the event rate was higher in the iopromide arm (p = 0.045). No cases of permanent CIN or significant differences in terms of AEs or GFR %Δ were observed. Our results suggest a more favorable safety profile of iodixanol versus iopromide. Adequately sized trials with similar design are warranted to confirm our findings and clarify the underlying biological mechanisms.

Incidence of contrast-induced acute kidney injury (CI-AKI) in high-risk oncology patients undergoing contrast-enhanced CT with a reduced dose of the iso-osmolar iodinated contrast medium iodixanol

“…However, most study reports evaluating the incidence of CI-AKI focused on low-osmolar contrast agents [11,33]. Recent data support the use of iso-osmolar contrast media to prevent CI-AKI both for intravenous and intraarterial administration, particularly in the setting of CKD [34][35][36][37]. In a randomized clinical trial performed in cancer patients, Terrenato et al reported a more favorable safety profile of Iodixanol vs. Iopromide [37].…”

Acute kidney injury from contrast-enhanced CT procedures in patients with cancer: white paper to highlight its clinical relevance and discuss applicable preventive strategies

“…These results suggested a lower incidence of AKI in patients who have undergone an intravenous injection of IOCM (4/247; ie, 1.6%), compared with iopromide (p=0.045), suggesting a more favourable safety profile of iodixanol versus iopromide. 55 IOCM proved also to be safe for kidney function in two studies involving chronic dialysis patients, independently of the route of administration (intravenous vs intraarterial); indeed, the use of iodixanol did not result in further increase of SCr. 56 57 The CONNECT(Clinical Evaluation Of Remote NotificatioN to rEduCe Time to Clinical Decision) Italian observational study showed that in the setting of hospital CT radiology units, where guidelinerecommended strategies for PC-AKI prevention may not be consistently followed, the use of the IOCM iodixanol appears to be associated with a lower incidence of PC-AKI in at-risk patients.…”

Prevention of post-contrast kidney injury in patients with cancer

“…PC-AKI was significantly more frequent with iopromide than with iodixanol (15 vs 5; p=0.11). 57 Several guidelines recommend that iodinated CM with the lowest osmolarity should be used in any patient and that iso-osmolar CM should be always used in patients with high risk of PC-AKI, including those with ischaemic heart disease, chronic kidney disease and advanced age. 14,33,35…”

“… 56 More recently, a clinical trial on patients with cancer evaluated the safety of iodixanol or iopromide. 57 All the patients had an estimated glomerular filtration rate (eGFR) of >60 mL/min/1.73 m 2 (without differences between groups) and underwent chest, abdomen and pelvis contrast-enhanced CT with iodinated CM. PC-AKI was significantly more frequent with iopromide than with iodixanol (15 vs 5; p =0.11).…”