Document Detail


Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: a randomized trial. The Iohexol Cooperative Study.
MedLine Citation:
PMID:  7731155     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The incidence of nephrotoxicity occurring with the nonionic contrast agent, iohexol, and the ionic contrast agent, meglumine/sodium diatrizoate, was compared in 1196 patients undergoing cardiac angiography in a prospective, randomized, double-blind multicenter trial. Patients were stratified into four groups: renal insufficiency (RI), diabetes mellitus (DM) both absent (N = 364); RI absent, DM present (N = 318); RI present, DM absent (N = 298); and RI and DM both present (N = 216). Serum creatinine levels were measured at -18 to 24, 0, and 24, 48, and 72 hours following contrast administration. Prophylactic hydration was administered pre- and post-angiography. Acute nephrotoxicity (increase in serum creatinine of > or = 1 mg/dl 48 to 72 hours post-contrast) was observed in 42 (7%) patients receiving diatrizoate compared to 19 (3%) patients receiving iohexol, P < 0.002. Differences in nephrotoxicity between the two contrast groups were confined to patients with RI alone or combined with DM. In a multivariate analysis, baseline serum creatinine, male gender, DM, volume of contrast agent, and RI were independently related to the risk of nephrotoxicity. Patients with RI receiving diatrizoate were 3.3 times as likely to develop acute nephrotoxicity compared to those receiving iohexol. Clinically severe adverse renal events were uncommon (N = 15) and did not differ in incidence between contrast groups (iohexol N = 6; diatrizoate N = 9). In conclusion, in patients undergoing cardiac angiography, only those with pre-existing RI alone or combined with DM are at higher risk for acute contrast nephrotoxicity.(ABSTRACT TRUNCATED AT 250 WORDS)
Authors:
M R Rudnick; S Goldfarb; L Wexler; P A Ludbrook; M J Murphy; E F Halpern; J A Hill; M Winniford; M B Cohen; D B VanFossen
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Kidney international     Volume:  47     ISSN:  0085-2538     ISO Abbreviation:  Kidney Int.     Publication Date:  1995 Jan 
Date Detail:
Created Date:  1995-06-01     Completed Date:  1995-06-01     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0323470     Medline TA:  Kidney Int     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  254-61     Citation Subset:  IM    
Affiliation:
Division of Nephrology, Graduate Hospital, University of Pennsylvania School of Medicine, Philadelphia, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angiocardiography*
Diabetes Complications
Diatrizoate Meglumine / administration & dosage,  adverse effects*
Double-Blind Method
Female
Humans
Incidence
Infusions, Intravenous
Iohexol / administration & dosage,  adverse effects*
Kidney Failure / chemically induced*
Kidney Failure, Acute / chemically induced,  complications
Male
Middle Aged
Prospective Studies
Risk Factors
Chemical
Reg. No./Substance:
131-49-7/Diatrizoate Meglumine; 66108-95-0/Iohexol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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