Nephrotoxicity of low-osmolality versus iso-osmolality contrast agents: Impact of N-acetylcysteine

Carlo Briguori, Antonio Colombo, Flavio Airoldi, Nuccia Morici, Giuseppe Massimo Sangiorgi, Anna Violante, Amelia Focaccio, Matteo Montorfano, Mauro Carlino, Gianluigi Condorelli, Bruno Ricciardelli

Research output: Contribution to journalArticle

Abstract

Background. Recent data support that iodixanol, an iso-osmolality contrast agent, is less nephrotoxic than low-osmolality contrast agents when hydration is the only prophylactic strategy used. We evaluated the nephrotoxicity of iso- and low-osmolality contrast agents with prophylactic administration of N-acetylcysteine (NAC) along with hydration. Methods. Two hundred and twenty-five patients with chronic renal insufficiency (serum creatinine >1.5 mg/dL or an estimated glomerular filtration rate 2), referred to our institution for coronary and/or peripheral procedures, were assigned to receive low-osmolality (iobitridol group; N = 115) or iso-osmolality (iodixanol group; N = 110) contrast dye. In all cases prophylactic administration of 0.45% saline intravenously and NAC (1200 mg orally twice daily) was used. Results. Baseline creatinine levels were similar in the 2 groups [iobitridol group = 1.70 (IQR: 1.54-1.98) mg/dL; iodixanol group = 1.73 (IQR: 1.56-2.00) mg/dL, P = 0.33]. The risk score for contrast nephrotoxicity was 5.0 ± 1.6 in the iobitridol group versus 5.0 ± 1.8 in the iodixanol group (P = 0.44). Increase of at least 0.5 mg/dL of the creatinine concentration 48 hours after the procedure occurred in 4/115 patients (3.5%) in the iobitridol group and 3/110 patients (2.7%) in the iodixanol group (P = 1.00; OR 0.78; 95% CI 0.17-3.56). Amount of contrast media administration was similar in the 2 groups (iobitridol group = 167 ± 90 mL; iodixanol group = 164 ± 82 mL; P = 0.61). Conclusion. Nephrotoxicity of iso-osmolality and low-osmolality contrast agents was similar when a prophylactic strategy of hydration plus NAC was utilized.

Original languageEnglish
Pages (from-to)2250-2255
Number of pages6
JournalKidney International
Volume68
Issue number5
DOIs
Publication statusPublished - Nov 2005

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Acetylcysteine
Osmolar Concentration
Contrast Media
Creatinine
Glomerular Filtration Rate
Chronic Renal Insufficiency
iodixanol
Coloring Agents
iobitridol
Serum

Keywords

  • Complications
  • Contrast media
  • Kidney
  • Prevention

ASJC Scopus subject areas

  • Nephrology

Cite this

Briguori, C., Colombo, A., Airoldi, F., Morici, N., Sangiorgi, G. M., Violante, A., ... Ricciardelli, B. (2005). Nephrotoxicity of low-osmolality versus iso-osmolality contrast agents: Impact of N-acetylcysteine. Kidney International, 68(5), 2250-2255. https://doi.org/10.1111/j.1523-1755.2005.00683.x

Nephrotoxicity of low-osmolality versus iso-osmolality contrast agents : Impact of N-acetylcysteine. / Briguori, Carlo; Colombo, Antonio; Airoldi, Flavio; Morici, Nuccia; Sangiorgi, Giuseppe Massimo; Violante, Anna; Focaccio, Amelia; Montorfano, Matteo; Carlino, Mauro; Condorelli, Gianluigi; Ricciardelli, Bruno.

In: Kidney International, Vol. 68, No. 5, 11.2005, p. 2250-2255.

Research output: Contribution to journalArticle

Briguori, Carlo ; Colombo, Antonio ; Airoldi, Flavio ; Morici, Nuccia ; Sangiorgi, Giuseppe Massimo ; Violante, Anna ; Focaccio, Amelia ; Montorfano, Matteo ; Carlino, Mauro ; Condorelli, Gianluigi ; Ricciardelli, Bruno. / Nephrotoxicity of low-osmolality versus iso-osmolality contrast agents : Impact of N-acetylcysteine. In: Kidney International. 2005 ; Vol. 68, No. 5. pp. 2250-2255.
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abstract = "Background. Recent data support that iodixanol, an iso-osmolality contrast agent, is less nephrotoxic than low-osmolality contrast agents when hydration is the only prophylactic strategy used. We evaluated the nephrotoxicity of iso- and low-osmolality contrast agents with prophylactic administration of N-acetylcysteine (NAC) along with hydration. Methods. Two hundred and twenty-five patients with chronic renal insufficiency (serum creatinine >1.5 mg/dL or an estimated glomerular filtration rate 2), referred to our institution for coronary and/or peripheral procedures, were assigned to receive low-osmolality (iobitridol group; N = 115) or iso-osmolality (iodixanol group; N = 110) contrast dye. In all cases prophylactic administration of 0.45{\%} saline intravenously and NAC (1200 mg orally twice daily) was used. Results. Baseline creatinine levels were similar in the 2 groups [iobitridol group = 1.70 (IQR: 1.54-1.98) mg/dL; iodixanol group = 1.73 (IQR: 1.56-2.00) mg/dL, P = 0.33]. The risk score for contrast nephrotoxicity was 5.0 ± 1.6 in the iobitridol group versus 5.0 ± 1.8 in the iodixanol group (P = 0.44). Increase of at least 0.5 mg/dL of the creatinine concentration 48 hours after the procedure occurred in 4/115 patients (3.5{\%}) in the iobitridol group and 3/110 patients (2.7{\%}) in the iodixanol group (P = 1.00; OR 0.78; 95{\%} CI 0.17-3.56). Amount of contrast media administration was similar in the 2 groups (iobitridol group = 167 ± 90 mL; iodixanol group = 164 ± 82 mL; P = 0.61). Conclusion. Nephrotoxicity of iso-osmolality and low-osmolality contrast agents was similar when a prophylactic strategy of hydration plus NAC was utilized.",
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T2 - Impact of N-acetylcysteine

AU - Briguori, Carlo

AU - Colombo, Antonio

AU - Airoldi, Flavio

AU - Morici, Nuccia

AU - Sangiorgi, Giuseppe Massimo

AU - Violante, Anna

AU - Focaccio, Amelia

AU - Montorfano, Matteo

AU - Carlino, Mauro

AU - Condorelli, Gianluigi

AU - Ricciardelli, Bruno

PY - 2005/11

Y1 - 2005/11

N2 - Background. Recent data support that iodixanol, an iso-osmolality contrast agent, is less nephrotoxic than low-osmolality contrast agents when hydration is the only prophylactic strategy used. We evaluated the nephrotoxicity of iso- and low-osmolality contrast agents with prophylactic administration of N-acetylcysteine (NAC) along with hydration. Methods. Two hundred and twenty-five patients with chronic renal insufficiency (serum creatinine >1.5 mg/dL or an estimated glomerular filtration rate 2), referred to our institution for coronary and/or peripheral procedures, were assigned to receive low-osmolality (iobitridol group; N = 115) or iso-osmolality (iodixanol group; N = 110) contrast dye. In all cases prophylactic administration of 0.45% saline intravenously and NAC (1200 mg orally twice daily) was used. Results. Baseline creatinine levels were similar in the 2 groups [iobitridol group = 1.70 (IQR: 1.54-1.98) mg/dL; iodixanol group = 1.73 (IQR: 1.56-2.00) mg/dL, P = 0.33]. The risk score for contrast nephrotoxicity was 5.0 ± 1.6 in the iobitridol group versus 5.0 ± 1.8 in the iodixanol group (P = 0.44). Increase of at least 0.5 mg/dL of the creatinine concentration 48 hours after the procedure occurred in 4/115 patients (3.5%) in the iobitridol group and 3/110 patients (2.7%) in the iodixanol group (P = 1.00; OR 0.78; 95% CI 0.17-3.56). Amount of contrast media administration was similar in the 2 groups (iobitridol group = 167 ± 90 mL; iodixanol group = 164 ± 82 mL; P = 0.61). Conclusion. Nephrotoxicity of iso-osmolality and low-osmolality contrast agents was similar when a prophylactic strategy of hydration plus NAC was utilized.

AB - Background. Recent data support that iodixanol, an iso-osmolality contrast agent, is less nephrotoxic than low-osmolality contrast agents when hydration is the only prophylactic strategy used. We evaluated the nephrotoxicity of iso- and low-osmolality contrast agents with prophylactic administration of N-acetylcysteine (NAC) along with hydration. Methods. Two hundred and twenty-five patients with chronic renal insufficiency (serum creatinine >1.5 mg/dL or an estimated glomerular filtration rate 2), referred to our institution for coronary and/or peripheral procedures, were assigned to receive low-osmolality (iobitridol group; N = 115) or iso-osmolality (iodixanol group; N = 110) contrast dye. In all cases prophylactic administration of 0.45% saline intravenously and NAC (1200 mg orally twice daily) was used. Results. Baseline creatinine levels were similar in the 2 groups [iobitridol group = 1.70 (IQR: 1.54-1.98) mg/dL; iodixanol group = 1.73 (IQR: 1.56-2.00) mg/dL, P = 0.33]. The risk score for contrast nephrotoxicity was 5.0 ± 1.6 in the iobitridol group versus 5.0 ± 1.8 in the iodixanol group (P = 0.44). Increase of at least 0.5 mg/dL of the creatinine concentration 48 hours after the procedure occurred in 4/115 patients (3.5%) in the iobitridol group and 3/110 patients (2.7%) in the iodixanol group (P = 1.00; OR 0.78; 95% CI 0.17-3.56). Amount of contrast media administration was similar in the 2 groups (iobitridol group = 167 ± 90 mL; iodixanol group = 164 ± 82 mL; P = 0.61). Conclusion. Nephrotoxicity of iso-osmolality and low-osmolality contrast agents was similar when a prophylactic strategy of hydration plus NAC was utilized.

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KW - Contrast media

KW - Kidney

KW - Prevention

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