We compared the Swedish Coronary Angiography and Angioplasty Registry with the Swedish 'Hospital Discharge Register' to assess
contrast media (CM)-induced
renal failure. Hospitals used only one type CM. From 2000 to 2003,
iodixanol (iso-osmolar) was used in 45 485 patients,
ioxaglate (low osmolar) in 12 440 subjects. To include the earlier used CM
iohexol (low osmolar), analysis extended back to 1990 (86 334 patients). Incidence of clinically significant
renal failure was greatest for patients receiving the iso-osmolar CM
iodixanol (1.7%).
Ioxaglate-treated patients had a significantly lower
renal failure incidence (0.8%, P<0.001). The odds ratio for
iodixanol-treated patients was significantly higher than for
ioxaglate (1 vs 0.48, P<0.001). In subsets of either diabetic patients or patients with previous
renal failure, odds ratios for
renal failure remained greater in the
iodixanol groups (P<0.01). Hospitals switching CM to
iodixanol experienced a doubling in clinically significant
renal failure after cardiac procedures. Dialysis was required in 0.2% of patients receiving
iodixanol, which was significantly higher (P<0.01) than for
ioxaglate-treated patients (0.1%).
Iohexol-treated patients had a similar low risk for developing clinically significant
renal failure (0.9%) as
ioxaglate. In conclusion, risk of developing
renal failure and required dialysis after coronary procedures is higher when patients received
iodixanol than
ioxaglate or
iohexol.