No Differences in CIN Shown Between Iodixanol, Iopamidol
Mean increases in serum creatinine levels smaller in patients treated with iopamidol.
The iso-osmolar contrast agent iodixanol demonstrated no difference in the rates of contrast-induced nephropathy compared with the low osmolar contrast agent iopamidol in high-risk patients, according to new results from the CARE trial.
CARE, presented by Richard Solomon, MD, Professor of Medicine at the University of Vermont, was the largest randomized trial to compare the effects of the two contrast agents in patients at high risk for CIN. The trial involved 414 patients who were undergoing cardiac angiography; patients were randomized to treatment with either iopamidol (Isovue, Bracco) or iodixanol (Visipaque, GE Heathcare).
Solomon said this study was important because contrast-induced nephropathy is a leading cause of morbidity and mortality following cardiac angiography.
“There was no significant difference in the incidence of contrast-induced nephropathy between patients treated with iopamidol and those treated with iodixanol,” Solomon said.
Changes in serum creatinine of at least 0.5 mg/dL occurred in 4.4% of iopamidol patients vs. 6.7% of iodixanol patients (P = .39).
There was also no difference in results among subsets of patients in various high-risk categories, including those with chronic kidney disease or diabetes and those who underwent PCI.
However, iopamidol was associated with a significantly smaller mean increase in serum creatinine compared with iodixanol, for both the total cohort and the subset of patients with diabetes.
ICON trial
The ICON trial, presented by Roxana Mehran, MD, from the Cardiovascular Research Foundation and Columbia University Medical Center, was a similar study that examined administration of the low-osmolar contrast agent ioxaglate (Hexabrix, Mallinckrodt Medical) vs. treatment with iodixanol in patients at high risk for contrast-induced nephropathy.
The study was heralded for specifically examining patients in high-risk categories, including those with chronic kidney disease.
The ICON trial included 145 patients with stable chronic renal failure undergoing percutaneous coronary diagnostic or interventional procedures. The primary endpoint was peak increase in serum creatinine levels from baseline to day three.
By day three, the mean increase in serum creatinine levels was
0.35 mg/dL in patients given ioxaglate and 0.2 mg/dL in patients treated with iodixanol (P = .08). Patients treated with ioxaglate were more likely to have higher increases in serum creatinine levels.
Mehran said in high-risk patients, treatment with ioxaglate may be optimal. “As compared with ioxaglate, iodixanol was not associated with a significant reduction of serum creatinine increase after coronary catheterization or percutaneous coronary intervention in patients with chronic kidney disease,” she said.