Iodixanol versus iopromide in cancer patients: Evidence from a randomized clinical trial.

Abstract

To assess the safety profile of iso-osmolar contrast medium (CM) versus low osmolar CM in cancer patients with an estimated glomerular filtration rate (eGFR) >60 ml/min. In this multicenter, blind trial of patients seeking a chest-abdomen-pelvis contrast enhanced computed tomography (CT) with iodated CM, participants were centrally randomized to iodixanol or iopromide. Contrast induced nephropathy (CIN) at 24 and/or 72 hr were our primary outcomes. We further considered irreversible CIN, average eGFR percentage variation (%Δ), and adverse events (AEs). Overall, 607 patients were enrolled. Among them, 497 eligible patients were randomized to iodixanol (N: 247) or iopromide (N: 250). No differences emerged by descriptive characteristics. Seven and 3 CIN at 24 hr (p = 0.34) and 8 and 2 CIN at 72 hr (p = 0.11) occurred in the iopromide and iodixanol group, respectively. Within the subgroup of individual patients who developed CIN (N: 17), the event rate was higher in the iopromide arm (p = 0.045). No cases of permanent CIN or significant differences in terms of AEs or GFR %Δ were observed. Our results suggest a more favorable safety profile of iodixanol versus iopromide. Adequately sized trials with similar design are warranted to confirm our findings and clarify the underlying biological mechanisms.

• Authors: Irene Terrenato, Francesca Sperati, Felice Musicco, Anna F Pozzi, Annunziata di Turi, Mauro Caterino, Elisabetta de Lutio di Castelguidone, Sergio V Setola, Massimo Bellomi, Carlo E Neumaier, Laura Conti, Giovanni Cigliana, Roberta Merola, Anna Antenucci, Giulia Orlandi, Antonio Giordano, Maddalena Barba, Stefano Canitano
• Journal: Journal of cellular physiology (J Cell Physiol) Vol. 233 Issue 3 Pg. 2572-2580 (Mar 2018) ISSN: 1097-4652 [Electronic] United States
• PMID: 28777459 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: © 2017 Wiley Periodicals, Inc.

Chemical References

• Contrast Media
• Triiodobenzoic Acids
• Iohexol
• iopromide
• iodixanol

Topics

• Adolescent
• Adult
• Aged
• Contrast Media (administration & dosage, adverse effects)
• Female
• Glomerular Filtration Rate (drug effects)
• Humans
• Iohexol (administration & dosage, adverse effects, analogs & derivatives)
• Italy
• Kidney (drug effects, physiopathology)
• Kidney Diseases (chemically induced, diagnosis, physiopathology)
• Male
• Middle Aged
• Neoplasms (diagnostic imaging, pathology)
• Patient Safety
• Predictive Value of Tests
• Risk Factors
• Time Factors
• Tomography, X-Ray Computed (adverse effects)
• Triiodobenzoic Acids (administration & dosage, adverse effects)
• Young Adult