Extended renal outcomes with use of iodixanol versus iohexol after coronary angiography.
Horng Ruey ChuaMark HorriganElizabeth McintoshRinaldo BellomoPublished in: BioMed research international (2014)
The impact of isoosmolar versus low-osmolar contrast media (CM) administration on contrast-induced acute kidney injury (CI-AKI) and extended renal dysfunction (ERD) is unclear. We retrospectively examined incidences of CI-AKI and ERD in patients who received iodixanol (isoosmolar) versus iohexol (low-osmolar) during angiography for cardiac indications. Of 713 patients, 560 (cohort A), 190 (cohort B), and 172 (cohort C) had serum creatinine monitored at 3 days, 30 days, and 6 months after angiography, respectively. 18% of cohort A developed CI-AKI, which was more common with iodixanol than iohexol (22% versus 13%, P = 0.006). However, patients given iodixanol were older with lower baseline estimated glomerular filtration rates (eGFR). On multivariate analysis, independent associations with higher CI-AKI risk include age >65 years, female gender, cardiac failure, ST-elevation myocardial infarction, intra-aortic balloon pump, and critical illness, but not CM type, higher CM load, or eGFR < 45 mL/min/1.73 m(2). 32% of cohort B and 34% of cohort C had ERD at 30 days and 6 months, while 44% and 41% of subcohorts had ERD at 90 days and 1 year, respectively. CI-AKI, but not CM type, was associated with medium- and longer-term ERD, with 3-fold higher risk. Advanced age, emergent cardiac conditions, and critical illness are stronger predictors of CI-AKI, compared with CM-related factors. CI-AKI predicts longer-term ERD.
Keyphrases
- acute kidney injury
- cardiac surgery
- end stage renal disease
- st elevation myocardial infarction
- left ventricular
- newly diagnosed
- chronic kidney disease
- small cell lung cancer
- ejection fraction
- computed tomography
- optical coherence tomography
- magnetic resonance
- percutaneous coronary intervention
- prognostic factors
- peritoneal dialysis
- preterm infants
- type diabetes
- tyrosine kinase
- coronary artery
- epidermal growth factor receptor
- high glucose
- oxidative stress
- acute coronary syndrome
- endothelial cells
- atrial fibrillation
- patient reported outcomes
- aortic valve
- preterm birth
- community dwelling
- uric acid
- drug induced