Korean Circ J.  2021 Feb;51(2):174-181. 10.4070/kcj.2020.0307.

Contrast Induced Nephropathy and 2-Year Outcomes of Iso-Osmolar Compared with Low-Osmolar Contrast Media after Elective Percutaneous Coronary Intervention

Affiliations
  • 1Department of Cardiology, The State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Abstract

Background and Objectives
This study investigated the relative incidence of contrast induced nephropathy (CIN) and long-term outcomes between iso-osmolar contrast media (IOCM) and low-osmolar contrast media (LOCM) undergoing elective percutaneous coronary intervention (PCI).
Methods
A total of 9,431 patients receiving elective PCI were enrolled in the cohort. The patients were divided into IOCM group and LOCM group. Propensity score matching (PSM) was applied to minimize the selection bias between groups.
Results
The multivariate analysis showed that the use of IOCM compared with LOCM did not affect the CIN incidence (odds ratio [OR], 0.912; 95% confidence interval [CI], 0.576–1.446; p=0.696). After PSM, the incidence of CIN was 1.5% and 4.0% in IOCM group (n=979) and LOCM group (n=979), respectively, p=0.001. IOCM significantly reduced the incidence of CIN compared with LOCM (OR, 0.393; 95% CI, 0.214–0.722; p=0.003). After 2 years of follow-up, the all-cause mortality was higher in IOCM group than LOCM group (2.1% vs. 0.9%, p<0.001). Cox regression analysis showed IOCM was not independent risk factor of 2-years all-cause mortality (OR, 0.849; 95% CI, 0.510–1.412; p=0.528). After PSM, the difference of all-cause death between groups disappeared (1.7% vs. 1.9%, p=0.739). Cox regression analysis showed that the use of IOCM compared with LOCM did not affect the incidence of 2-year all-cause mortality (OR, 1.037; 95% CI, 0.534–2.014; p=0.915).
Conclusions
Compared with LOCM, IOCM significantly reduced the incidence of CIN after elective PCI, but had no significant effect on 2-year all-cause mortality.

Keyword

Contrast media; Percutaneous coronary intervention; Coronary artery disease

Figure

  • Figure 1 Survival curves (Kaplan-Meier analysis) for all-cause mortality at 2 years.IOCM = iso-osmolar contrast media; LOCM = low-osmolar contrast media; PSM = propensity score matching.


Cited by  1 articles

Iso-osmolar Iodixanol Is Better than Low-osmolar Contrast for CIN Prevention. And Then?
Sang-Ho Jo
Korean Circ J. 2021;51(2):182-184.    doi: 10.4070/kcj.2021.0003.


Reference

1. Seeliger E, Sendeski M, Rihal CS, Persson PB. Contrast-induced kidney injury: mechanisms, risk factors, and prevention. Eur Heart J. 2012; 33:2007–2015. PMID: 22267241.
Article
2. Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006; S11–S15. PMID: 16612394.
Article
3. Aspelin P, Aubry P, Fransson SG, et al. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med. 2003; 348:491–499. PMID: 12571256.
Article
4. Azzalini L, Vilca LM, Lombardo F, et al. Incidence of contrast-induced acute kidney injury in a large cohort of all-comers undergoing percutaneous coronary intervention: comparison of five contrast media. Int J Cardiol. 2018; 273:69–73. PMID: 30196995.
Article
5. From AM, Al Badarin FJ, McDonald FS, Bartholmai BJ, Cha SS, Rihal CS. Iodixanol versus low-osmolar contrast media for prevention of contrast induced nephropathy: meta-analysis of randomized, controlled trials. Circ Cardiovasc Interv. 2010; 3:351–358. PMID: 20647563.
6. Mruk B. Renal safety of iodinated contrast media depending on their osmolarity - current outlooks. Pol J Radiol. 2016; 81:157–165. PMID: 27141236.
Article
7. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012; 120:c179–84. PMID: 22890468.
Article
8. Levey AS, Coresh J, Greene T, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006; 145:247–254. PMID: 16908915.
Article
9. Stacul F, van der Molen AJ, Reimer P, et al. Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol. 2011; 21:2527–2541. PMID: 21866433.
Article
10. Jo SH, Youn TJ, Koo BK, et al. Renal toxicity evaluation and comparison between visipaque (iodixanol) and hexabrix (ioxaglate) in patients with renal insufficiency undergoing coronary angiography: the RECOVER study: a randomized controlled trial. J Am Coll Cardiol. 2006; 48:924–930. PMID: 16949481.
11. McCullough PA, Bertrand ME, Brinker JA, Stacul F. A meta-analysis of the renal safety of isosmolar iodixanol compared with low-osmolar contrast media. J Am Coll Cardiol. 2006; 48:692–699. PMID: 16904536.
Article
12. Hossain MA, Costanzo E, Cosentino J, et al. Contrast-induced nephropathy: pathophysiology, risk factors, and prevention. Saudi J Kidney Dis Transpl. 2018; 29:1–9. PMID: 29456202.
Article
13. Fähling M, Seeliger E, Patzak A, Persson PB. Understanding and preventing contrast-induced acute kidney injury. Nat Rev Nephrol. 2017; 13:169–180. PMID: 28138128.
Article
14. Scharnweber T, Alhilali L, Fakhran S. Contrast-induced acute kidney injury: pathophysiology, manifestations, prevention, and management. Magn Reson Imaging Clin N Am. 2017; 25:743–753. PMID: 28964464.
15. McCullough PA. Contrast-induced acute kidney injury. J Am Coll Cardiol. 2008; 51:1419–1428. PMID: 18402894.
Article
16. Zhao F, Lei R, Yang SK, et al. Comparative effect of iso-osmolar versus low-osmolar contrast media on the incidence of contrast-induced acute kidney injury in diabetic patients: a systematic review and meta-analysis. Cancer Imaging. 2019; 19:38. PMID: 31215488.
Article
17. Newhouse JH, Kho D, Rao QA, Starren J. Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity. AJR Am J Roentgenol. 2008; 191:376–382. PMID: 18647905.
Article
18. Reed M, Meier P, Tamhane UU, Welch KB, Moscucci M, Gurm HS. The relative renal safety of iodixanol compared with low-osmolar contrast media: a meta-analysis of randomized controlled trials. JACC Cardiovasc Interv. 2009; 2:645–654. PMID: 19628188.
19. Jost G, Lengsfeld P, Lenhard DC, Pietsch H, Hütter J, Sieber MA. Viscosity of iodinated contrast agents during renal excretion. Eur J Radiol. 2011; 80:373–377. PMID: 21376497.
Article
20. Bucher AM, De Cecco CN, Schoepf UJ, et al. Is contrast medium osmolality a causal factor for contrast-induced nephropathy? BioMed Res Int. 2014; 2014:931413. PMID: 24800254.
Article
21. Wang YC, Tang A, Chang D, Lu CQ, Zhang SJ, Ju S. Long-term adverse effects of low-osmolar compared with iso-osmolar contrast media after coronary angiography. Am J Cardiol. 2016; 118:985–990. PMID: 27521223.
Article
Full Text Links
  • KCJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr