Evaluation of the nephrotoxicity of iodixanol in patients with predisposing factors to contrast medium induced nephropathy referred for contrast enhanced computed tomography

To determine the risk of developing contrast induced nephropathy (CIN) in intermediate-risk patients receiving iodixanol, an iso-osmolar, dimeric non-ionic contrast agent, for CT in a clinical setting.

Hundred consecutive patients referred for a contrast enhanced CT with a serum creatinine concentration>1.1mg/dl and/or a glomerular filtration rate (GFR)<90ml/min were included. Exclusion criteria were a serum creatinine>2.0mg/dl and a GFR<30ml/min or concurrent nephrotoxic agents. Between 60 and 140ml (mean 97±42ml) iodixanol (320mgI/ml) were administered at a flow of 2.5–3ml/s. Hydration with 500ml NaCl i.v. was performed before and after contrast injection. Follow-up was completed in 99 patients (age, 64±13 years, 68 men). CIN was defined as increase in serum creatinine concentration +0.5mg/dl or >25% above baseline within 72h after contrast administration.

Serum creatinine concentration and GFR were 1.40±0.22, 1.29±0.29, and 1.26±0.29mg/dl and 52.2±13.9, 51.3±21.1, and 51.5±15.1ml/min on days 0, 3, and 7, respectively. Three out of 99 (3%) patients who received 90–110ml iodixanol revealed a CIN on day 3 without persistence on day 7. No specific therapy was needed. One out of 99 patients reported an exanthema on days 3 and 7.

With the use of iodixanol in intermediate-risk patients, 3% of the patients develop CIN on day 3 without need for a specific therapy or persistence on day 7.