December 4, 2008 - A first-ever 208-person study comparing the renal safety, occurrence of cardiovascular adverse events and diagnostic image quality of GE Healthcare's isosmolar contrast media (CM) iodixanol (Visipaque) and the low-osmolar CM iopromide in select patients concluded iodixanol is associated with lower incidence of contrast-induced neuropathy (CIN) and cardiovascular events (CV) than iopromide, when used in patients with chronic kidney disease.
The study is published in December’s Catheterization and Cardiovascular Interventions, a scientific journal that covers current hot topics in interventional imaging. The prospective, randomized, double-blind, single-center study was authored by Bin Nie, M.D. and colleagues from Beijing Anzhen Hospital, Beijing, People's Republic of China. The authors’ objective for the study was to compare the renal safety as well as cardiovascular effects and diagnostic image quality of iso-osmolar iodixanol vs. low-osmolar iopromide in patients with chronic kidney disease (CKD) undergoing coronary interventions.
“Given the increase in patients with CKD and also with heart disease we wanted to investigate if there was a difference in renal and cardiovascular complications between the isosmolar contrast medium iodixanol and the low osmolar contrast medium iopromide.” said Dr. Bin Nie. “These results may have an important influence in clinical decision making regarding the selection of the appropriate contrast media for the appropriate patient.”
The conclusion of the study indicates that isosmolar CM iodixanol appears to be associated with a significantly lower incidence of CIN and composite CV compared with the low-osmolar CM iopromide in patients with CKD undergoing coronary angiography with or without PCI. The authors indicated that there was no difference in image quality between the two contrast media, in spite of iopromide’s higher iodine content.
Prof. Yu-jie Zhou, the correspondence author noted that in the paper that their results are of interest in light of the 2007 AHA/ACC guidelines for the management of patients with Unstable-Angina/Non-ST-Elevation Myocardial Infarction (UA/NSTEMI) and the AHA/ACC/SCAI 2007 Update of the Guidelines for PCI. These guidelines recommend the use of isosmolar contrast in patients with CKD who undergo coronary arteriography.
The authors noted however, that their study did not match with another recent study, likely due to different standards for measuring Serum Creatinine levels (SCr) post-dose. They wrote “For a given study population, non-standardized measurement of post-procedure SCr at one random time point may not accurately reflect the true incidence of CIN, as different CM may exert their maximal effect on the kidney at different time points after administration in different individuals. The critical role of standardized timing in post-procedure SCr measurement is illustrated by our findings that on day two after CM administration peak SCr levels were observed in 90 and 82 percent of patients who received iodixanol and iopromide, respectively, whereas on day three the corresponding peak SCr increases occurred in 10 and 18 percent of patients.”
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