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Risk of contrast-medium-induced nephropathy in high-risk patients undergoing MDCT – A pooled analysis of two randomized trials

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Abstract

The incidence of contrast-medium-induced nephropathy (CIN) following intravenous (IV) CM administration of contrast media to renally impaired patients undergoing multidetector computed tomography (MDCT) is not well characterized. Our objective was to investigate the incidence of CIN in patients with glomerular filtration rate (GFR) <60 ml/min undergoing contrast-enhanced MDCT examinations and to compare the rates of CIN following the IV administration of low-osmolar contrast media (LOCM, iopamidol and iomeprol) and an iso-osmolar contrast medium (IOCM, iodixanol). A total of 301 adult patients with moderate-to-severe renal failure received a similar IV contrast dose (40 gI). Serum creatinine (SCr) was measured at screening, baseline and 48–72 ± 6 h after the MDCT examination. Primary CIN outcome was an increase in SCr ≥0.5 mg/dl (≥44.2 μmol/l) from baseline. The CIN rates were 2.3% in the total population, 0.6% when GFR >40 ml/min, 4.6% when GFR <40 ml/min and 7.8% in patients with GFR <30 ml/min. The incidence of CIN was significantly higher after iodixanol than after LOCM (seven patients, 4.7% following IOCM, no CIN cases following the LOCM; p = 0.007). Significant differences in favor of the LOCM were also observed in patients with GFR <40 ml/min and GFR <30 ml/min. Following the IV administration of nonionic contrast agents in patients with moderate-to-severe renal insufficiency, the risk of significant CIN seems to be low. The IOCM iodixanol caused a higher rate of CIN than the LOCM iopamidol and iomeprol, especially in high-risk patients. Differences in osmolality between these LOCM and iodixanol do not play a role in the genesis of CIN.

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Acknowledgments

The two original studies were supported by a research grant from Bracco Diagnostics, Inc., Princeton, NJ. The authors thank Bracco Diagnostics, Inc., for the unlimited access to the database of the IMPACT and ACTIVE studies and Ningyan Shen, MD, PhD for the valuable support to our analysis.

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Correspondence to Henrik S. Thomsen.

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Thomsen, H.S., Morcos, S.K. Risk of contrast-medium-induced nephropathy in high-risk patients undergoing MDCT – A pooled analysis of two randomized trials. Eur Radiol 19, 891–897 (2009). https://doi.org/10.1007/s00330-008-1206-4

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  • DOI: https://doi.org/10.1007/s00330-008-1206-4

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