Ionic low-osmolar versus nonionic iso-osmolar contrast media to obviate worsening nephropathy after angioplasty in chronic renal failure patients: the ICON (Ionic versus non-ionic Contrast to Obviate worsening Nephropathy after angioplasty in chronic renal failure patients) study
This randomized, prospective, double-blind, multicenter study compared nephrotoxicity of the nonionic iso-osmolar contrast media (CM) iodixanol versus the ionic low-osmolar CM ioxaglate in patients with chronic renal insufficiency undergoing coronary angiography. The properties of iodinated CM might...
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Veröffentlicht in: | JACC. Cardiovascular interventions 2009-05, Vol.2 (5), p.415 |
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creator | Mehran, Roxana Nikolsky, Eugenia Kirtane, Ajay J Caixeta, Adriano Wong, S Chiu Teirstein, Paul S Downey, William E Batchelor, Wayne B Casterella, Peter J Kim, Young-Hak Fahy, Martin Dangas, George D |
description | This randomized, prospective, double-blind, multicenter study compared nephrotoxicity of the nonionic iso-osmolar contrast media (CM) iodixanol versus the ionic low-osmolar CM ioxaglate in patients with chronic renal insufficiency undergoing coronary angiography.
The properties of iodinated CM might contribute to the incidence of contrast-induced nephropathy (CIN).
Patients with renal impairment undergoing coronary angiography were randomly assigned to iodixanol (n = 72) or ioxaglate (n = 74).
Baseline characteristics were well-matched between the 2 groups. The predicted risk score for CIN was similar in the iodixanol and in the ioxaglate groups (11.9 +/- 4.1 vs. 11.8 +/- 4.1), as was the use of N-acetylcysteine (70% vs. 73%). The primary end point of the study, median peak increase of serum creatinine from day 0 through day 3 after angiography, did not differ between the iodixanol (0.09 mg/dl; interquartile range 0.00 to 0.30 mg/dl) and the ioxaglate (0.15 mg/dl; interquartile range 0.00 to 0.40 mg/dl; p = 0.07) groups. The percentages of patients with a peak increase of serum creatinine >or=0.5 mg/dl (15.9% in iodixanol vs. 18.2% in ioxaglate), >or=1.0 mg/dl (1.4% vs. 4.5%), and >or=25% or >or=0.5 mg/dl (15.9% vs. 24.2%, respectively) also did not differ significantly between the 2 groups.
In high-risk patients undergoing coronary angiographic procedures, use of the nonionic iso-osmolar CM iodixanol does not reduce renal deterioration in patients with renal impairment, compared with the ionic low-osmolar CM ioxaglate. Given that the study was underpowered to compare nephrotoxicity of the 2 groups under the active medical protection of CIN, a larger randomized study is warranted that will enroll patients with higher risks of CIN under a strict control of hydration regimens and adjunctive medications. |
doi_str_mv | 10.1016/j.jcin.2009.03.007 |
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The properties of iodinated CM might contribute to the incidence of contrast-induced nephropathy (CIN).
Patients with renal impairment undergoing coronary angiography were randomly assigned to iodixanol (n = 72) or ioxaglate (n = 74).
Baseline characteristics were well-matched between the 2 groups. The predicted risk score for CIN was similar in the iodixanol and in the ioxaglate groups (11.9 +/- 4.1 vs. 11.8 +/- 4.1), as was the use of N-acetylcysteine (70% vs. 73%). The primary end point of the study, median peak increase of serum creatinine from day 0 through day 3 after angiography, did not differ between the iodixanol (0.09 mg/dl; interquartile range 0.00 to 0.30 mg/dl) and the ioxaglate (0.15 mg/dl; interquartile range 0.00 to 0.40 mg/dl; p = 0.07) groups. The percentages of patients with a peak increase of serum creatinine >or=0.5 mg/dl (15.9% in iodixanol vs. 18.2% in ioxaglate), >or=1.0 mg/dl (1.4% vs. 4.5%), and >or=25% or >or=0.5 mg/dl (15.9% vs. 24.2%, respectively) also did not differ significantly between the 2 groups.
In high-risk patients undergoing coronary angiographic procedures, use of the nonionic iso-osmolar CM iodixanol does not reduce renal deterioration in patients with renal impairment, compared with the ionic low-osmolar CM ioxaglate. Given that the study was underpowered to compare nephrotoxicity of the 2 groups under the active medical protection of CIN, a larger randomized study is warranted that will enroll patients with higher risks of CIN under a strict control of hydration regimens and adjunctive medications.</description><identifier>EISSN: 1876-7605</identifier><identifier>DOI: 10.1016/j.jcin.2009.03.007</identifier><identifier>PMID: 19463464</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Angioplasty, Balloon ; Contrast Media - adverse effects ; Coronary Angiography ; Coronary Artery Disease - complications ; Coronary Artery Disease - diagnosis ; Creatinine ; Double-Blind Method ; Female ; Humans ; Ioxaglic Acid - adverse effects ; Kidney Diseases - chemically induced ; Kidney Failure, Chronic - physiopathology ; Kidney Failure, Chronic - prevention & control ; Male ; Risk Assessment ; Time Factors ; Triiodobenzoic Acids - adverse effects</subject><ispartof>JACC. Cardiovascular interventions, 2009-05, Vol.2 (5), p.415</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27931,27932</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19463464$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mehran, Roxana</creatorcontrib><creatorcontrib>Nikolsky, Eugenia</creatorcontrib><creatorcontrib>Kirtane, Ajay J</creatorcontrib><creatorcontrib>Caixeta, Adriano</creatorcontrib><creatorcontrib>Wong, S Chiu</creatorcontrib><creatorcontrib>Teirstein, Paul S</creatorcontrib><creatorcontrib>Downey, William E</creatorcontrib><creatorcontrib>Batchelor, Wayne B</creatorcontrib><creatorcontrib>Casterella, Peter J</creatorcontrib><creatorcontrib>Kim, Young-Hak</creatorcontrib><creatorcontrib>Fahy, Martin</creatorcontrib><creatorcontrib>Dangas, George D</creatorcontrib><title>Ionic low-osmolar versus nonionic iso-osmolar contrast media to obviate worsening nephropathy after angioplasty in chronic renal failure patients: the ICON (Ionic versus non-ionic Contrast to Obviate worsening Nephropathy after angioplasty in chronic renal failure patients) study</title><title>JACC. Cardiovascular interventions</title><addtitle>JACC Cardiovasc Interv</addtitle><description>This randomized, prospective, double-blind, multicenter study compared nephrotoxicity of the nonionic iso-osmolar contrast media (CM) iodixanol versus the ionic low-osmolar CM ioxaglate in patients with chronic renal insufficiency undergoing coronary angiography.
The properties of iodinated CM might contribute to the incidence of contrast-induced nephropathy (CIN).
Patients with renal impairment undergoing coronary angiography were randomly assigned to iodixanol (n = 72) or ioxaglate (n = 74).
Baseline characteristics were well-matched between the 2 groups. The predicted risk score for CIN was similar in the iodixanol and in the ioxaglate groups (11.9 +/- 4.1 vs. 11.8 +/- 4.1), as was the use of N-acetylcysteine (70% vs. 73%). The primary end point of the study, median peak increase of serum creatinine from day 0 through day 3 after angiography, did not differ between the iodixanol (0.09 mg/dl; interquartile range 0.00 to 0.30 mg/dl) and the ioxaglate (0.15 mg/dl; interquartile range 0.00 to 0.40 mg/dl; p = 0.07) groups. The percentages of patients with a peak increase of serum creatinine >or=0.5 mg/dl (15.9% in iodixanol vs. 18.2% in ioxaglate), >or=1.0 mg/dl (1.4% vs. 4.5%), and >or=25% or >or=0.5 mg/dl (15.9% vs. 24.2%, respectively) also did not differ significantly between the 2 groups.
In high-risk patients undergoing coronary angiographic procedures, use of the nonionic iso-osmolar CM iodixanol does not reduce renal deterioration in patients with renal impairment, compared with the ionic low-osmolar CM ioxaglate. Given that the study was underpowered to compare nephrotoxicity of the 2 groups under the active medical protection of CIN, a larger randomized study is warranted that will enroll patients with higher risks of CIN under a strict control of hydration regimens and adjunctive medications.</description><subject>Aged</subject><subject>Angioplasty, Balloon</subject><subject>Contrast Media - adverse effects</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Disease - complications</subject><subject>Coronary Artery Disease - diagnosis</subject><subject>Creatinine</subject><subject>Double-Blind Method</subject><subject>Female</subject><subject>Humans</subject><subject>Ioxaglic Acid - adverse effects</subject><subject>Kidney Diseases - chemically induced</subject><subject>Kidney Failure, Chronic - physiopathology</subject><subject>Kidney Failure, Chronic - prevention & control</subject><subject>Male</subject><subject>Risk Assessment</subject><subject>Time Factors</subject><subject>Triiodobenzoic Acids - adverse effects</subject><issn>1876-7605</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqlkT1PwzAQhg0SolDYEQO6EYYE58uJ2VDER6WqXWCuLonTuErtyHZb5d8TKIWBkemGR_e-j-4IuQ6oH9CA3a_8VSmVH1LKfRr5lKbH5CzIUualjCYjcm7tilJGeRqeklHAYxbFLD47uppoJUto9c7Tdq1bNLAVxm4sqAF8MWn1Dyu1cgatg7WoJILToIutRCdgp40VSqolKNE1Rnfomh6wdsIAqqXUXTvs9SAVlAP-DDZCYQs1ynZjBAwLUihnH8A1Aib5fAa3e7lfIW9vlB8shv75n_7Z__rvwLpN1V-QkxpbKy6_55i8Pz-95a_edP4yyR-nXhPG3HksoUVVM4yiMGVYVJwFUcqrjCMvyyxBlmVCxGmRsCquAyp4xUsWJ1HCQqS8wGhMbva53aYYjrrojFyj6ReHF0UfyNObqw</recordid><startdate>200905</startdate><enddate>200905</enddate><creator>Mehran, Roxana</creator><creator>Nikolsky, Eugenia</creator><creator>Kirtane, Ajay J</creator><creator>Caixeta, Adriano</creator><creator>Wong, S Chiu</creator><creator>Teirstein, Paul S</creator><creator>Downey, William E</creator><creator>Batchelor, Wayne B</creator><creator>Casterella, Peter J</creator><creator>Kim, Young-Hak</creator><creator>Fahy, Martin</creator><creator>Dangas, George D</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope></search><sort><creationdate>200905</creationdate><title>Ionic low-osmolar versus nonionic iso-osmolar contrast media to obviate worsening nephropathy after angioplasty in chronic renal failure patients: the ICON (Ionic versus non-ionic Contrast to Obviate worsening Nephropathy after angioplasty in chronic renal failure patients) study</title><author>Mehran, Roxana ; Nikolsky, Eugenia ; Kirtane, Ajay J ; Caixeta, Adriano ; Wong, S Chiu ; Teirstein, Paul S ; Downey, William E ; Batchelor, Wayne B ; Casterella, Peter J ; Kim, Young-Hak ; Fahy, Martin ; Dangas, George D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-h249t-650bdf6a33276abd961379d89a9cc85a688ee47b56d4f10e9d9c6453562a09ba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Angioplasty, Balloon</topic><topic>Contrast Media - adverse effects</topic><topic>Coronary Angiography</topic><topic>Coronary Artery Disease - complications</topic><topic>Coronary Artery Disease - diagnosis</topic><topic>Creatinine</topic><topic>Double-Blind Method</topic><topic>Female</topic><topic>Humans</topic><topic>Ioxaglic Acid - adverse effects</topic><topic>Kidney Diseases - chemically induced</topic><topic>Kidney Failure, Chronic - physiopathology</topic><topic>Kidney Failure, Chronic - prevention & control</topic><topic>Male</topic><topic>Risk Assessment</topic><topic>Time Factors</topic><topic>Triiodobenzoic Acids - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mehran, Roxana</creatorcontrib><creatorcontrib>Nikolsky, Eugenia</creatorcontrib><creatorcontrib>Kirtane, Ajay J</creatorcontrib><creatorcontrib>Caixeta, Adriano</creatorcontrib><creatorcontrib>Wong, S Chiu</creatorcontrib><creatorcontrib>Teirstein, Paul S</creatorcontrib><creatorcontrib>Downey, William E</creatorcontrib><creatorcontrib>Batchelor, Wayne B</creatorcontrib><creatorcontrib>Casterella, Peter J</creatorcontrib><creatorcontrib>Kim, Young-Hak</creatorcontrib><creatorcontrib>Fahy, Martin</creatorcontrib><creatorcontrib>Dangas, George D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><jtitle>JACC. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mehran, Roxana</au><au>Nikolsky, Eugenia</au><au>Kirtane, Ajay J</au><au>Caixeta, Adriano</au><au>Wong, S Chiu</au><au>Teirstein, Paul S</au><au>Downey, William E</au><au>Batchelor, Wayne B</au><au>Casterella, Peter J</au><au>Kim, Young-Hak</au><au>Fahy, Martin</au><au>Dangas, George D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ionic low-osmolar versus nonionic iso-osmolar contrast media to obviate worsening nephropathy after angioplasty in chronic renal failure patients: the ICON (Ionic versus non-ionic Contrast to Obviate worsening Nephropathy after angioplasty in chronic renal failure patients) study</atitle><jtitle>JACC. Cardiovascular interventions</jtitle><addtitle>JACC Cardiovasc Interv</addtitle><date>2009-05</date><risdate>2009</risdate><volume>2</volume><issue>5</issue><spage>415</spage><pages>415-</pages><eissn>1876-7605</eissn><abstract>This randomized, prospective, double-blind, multicenter study compared nephrotoxicity of the nonionic iso-osmolar contrast media (CM) iodixanol versus the ionic low-osmolar CM ioxaglate in patients with chronic renal insufficiency undergoing coronary angiography.
The properties of iodinated CM might contribute to the incidence of contrast-induced nephropathy (CIN).
Patients with renal impairment undergoing coronary angiography were randomly assigned to iodixanol (n = 72) or ioxaglate (n = 74).
Baseline characteristics were well-matched between the 2 groups. The predicted risk score for CIN was similar in the iodixanol and in the ioxaglate groups (11.9 +/- 4.1 vs. 11.8 +/- 4.1), as was the use of N-acetylcysteine (70% vs. 73%). The primary end point of the study, median peak increase of serum creatinine from day 0 through day 3 after angiography, did not differ between the iodixanol (0.09 mg/dl; interquartile range 0.00 to 0.30 mg/dl) and the ioxaglate (0.15 mg/dl; interquartile range 0.00 to 0.40 mg/dl; p = 0.07) groups. The percentages of patients with a peak increase of serum creatinine >or=0.5 mg/dl (15.9% in iodixanol vs. 18.2% in ioxaglate), >or=1.0 mg/dl (1.4% vs. 4.5%), and >or=25% or >or=0.5 mg/dl (15.9% vs. 24.2%, respectively) also did not differ significantly between the 2 groups.
In high-risk patients undergoing coronary angiographic procedures, use of the nonionic iso-osmolar CM iodixanol does not reduce renal deterioration in patients with renal impairment, compared with the ionic low-osmolar CM ioxaglate. Given that the study was underpowered to compare nephrotoxicity of the 2 groups under the active medical protection of CIN, a larger randomized study is warranted that will enroll patients with higher risks of CIN under a strict control of hydration regimens and adjunctive medications.</abstract><cop>United States</cop><pmid>19463464</pmid><doi>10.1016/j.jcin.2009.03.007</doi></addata></record> |
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subjects | Aged Angioplasty, Balloon Contrast Media - adverse effects Coronary Angiography Coronary Artery Disease - complications Coronary Artery Disease - diagnosis Creatinine Double-Blind Method Female Humans Ioxaglic Acid - adverse effects Kidney Diseases - chemically induced Kidney Failure, Chronic - physiopathology Kidney Failure, Chronic - prevention & control Male Risk Assessment Time Factors Triiodobenzoic Acids - adverse effects |
title | Ionic low-osmolar versus nonionic iso-osmolar contrast media to obviate worsening nephropathy after angioplasty in chronic renal failure patients: the ICON (Ionic versus non-ionic Contrast to Obviate worsening Nephropathy after angioplasty in chronic renal failure patients) study |
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