Iodixanol nephrotoxicity

Lancelot E, Idee J M, Couturier V et al. I nfluence of the viscosity of iodixanol on medullary and cortical blood flow in the rat kidney a potential cause of nephrotoxicity. J Appl Toxicol 1999 19 341-346. 

A report from Italy has suggested that intravenous saline 0.4% before and after administration of the contrast medium, an infusion of dopamine 3 micrograms/kg/ minute for 24 hours after the contrast medium, intravenous furosemide 80 mg 30 minutes before the contrast medium, or intravenous mannitol (20%) 250 ml 1 horn-before and 1 hour after the contrast medium each prevented the reduction in renal function caused by the nonionic agents iobitridol, ioversol, or iodixanol (193). However, the protocol of the study was not described, and previous studies have shown that dopamine, furosemide, and mannitol do not offer good protection against contrast media-induced nephrotoxicity. On the other hand, volume expansion with intravenous saline has been found to offer some protection (190). 

In a meta-analysis of 25 randomized controlled trials involving 3270 patients, iodixanol was not associated with a significantly reduced risk of contrast-induced nephrotoxicity compared with all low-osmolar media pooled together (RR = 0.80 95% Cl = 0.61, 1.04) [12 ]. There were no significant risk reductions in subgroups after intravenous administration (RR = 1.08 95% Cl = 0.62, 1.89) or intra-arterial administration (RR = 0.68 95% Cl... 

Some practitioners advocate the use of oral 7V-acetylcysteine, although the evidence is conflicting. In a randomized placebo-controlled study of 200 patients who were given iodixanol, oral Al-acetylcysteine 600 mg bd the day before and on the day of the procedure or placebo were combined with intravenous saline 1 ml/kg/hour 12-24 hours before the procedure and 12-24 hours after [14 ]. The rates of contrast-induced nephrotoxicity were 8.1% in those who were given acetylcysteine and 5.9% in those who were given saline, a non-significant difference. The authors concluded that acetylcysteine did not prevent contrast-induced nephrotoxicity in patients who received iso-osmolar contrast media with adequate hydration. 

Heinrich MC, Haberle L, Muller V, Bautz W, Uder M. Nephrotoxicity of iso-osmolar iodixanol compared with nonionic low-osmolar contrast media meta-analysis of randomized controlled trials. Radiology 2009 250 68-86. 

Rudnick MR, Davidson C, Laskey W, Stafford JL, Sherwin PF Nephrotoxicity of iodixanol versus ioversol in patients with chronic kidney disease the visipaque angiography/ interventions with laboratory outcomes in renal insufficiency (VALOR) trial. Am Heart J 2008 156 776-782. 

Laskey W, Aspelin P, Davidson C, Rudnick M, Aubry P, Kumar S, Gietzen F, Wiemer M Nephrotoxicity of iodixanol versus iopamidol in patients with chronic kidney disease and diabetes mellitus undergoing coronary angiographic procedures. Am Heart J 2009 158 822-828 e823. 

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