July 30, 2009 – A new study comparing nephrotoxicity of the iso-osmolar contrast medium iodixanol to low-osmolar contrast media (LOCM) found iodixanol shows no reduction in contrast-induced acute kidney injury (CI-AKI) compared to some agents, which may prompt the ACC and AHA to change their current guidelines.
The research shows the more expensive iodixanol (Visipaque, made by GE Healthcare) is better than some of the less expensive LOCM, but is equal to others. The study found a reduction in CI-AKI when iodixanol was compared with ioxaglate and iohexol, but no difference when compared with iopromide (Ultravist, Bayer Healthcare) or ioversol (Optiray, Mallinckrodt).
Earlier studies showed iodixanol offered better kidney protection that LOCM, which led the ACC/AHA to set guidelines recommending iso-osmolar contrast media in patients with chronic kidney disease undergoing angiography. Iodixanol is the only FDA-cleared iso-osmolar agent. However, in addition to the current report, some recent larger randomized trials comparing iodixanol with different types of LOCM have shown no reduction in kidney injury. Experts say new data may prompt the ACC and AHA to review its guidelines.
The study, published in the July issue of JACC Cardiac Interventions, sought to compare the nephrotoxicity of the iso-osmolar contrast medium, iodixanol, to (LOCM). Researchers from the University of Michigan, VA Ann Arbor Healthcare System, and the University of Miami, Fla., looked at 2,763 patients from 16 trials between 1980 to November 2008, which compared the incidence of CI-AKI with either iodixanol or LOCM. Random-effects models were used to calculate summary risk ratios for CI-AKI, need for hemodialysis, and death.
The data shows no significant difference in the incidence of CI-AKI in the iodixanol group than in the LOCM group overall. There was no significant difference in the rates of post-procedure hemodialysis or death. The relative renal safety of LOCM compared with iodixanol may vary based on the specific type of LOCM.
The study authors said a prior meta-analysis suggested that iodixanol was associated with less CI-AKI than LOCM, but this study was limited by ascertainment bias and did not include the most recent randomized controlled trials.
For more information: http://interventions.onlinejacc.org