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Researchers make renal function finding

A study by MUSC researchers confirms the favorable safety profile of iodixanol, an isosmolar contrast medium, in patients undergoing computed tomography (CT) scans who may be at-risk for nephropathy, according to a study published in the July issue of the journal Radiology.
The use of iodixanol, developed by GE Healthcare, results in lower incidence of elevated serum creatinine (SCr) or decreased glomerular filtration rate (GFR) than another contrast medium, iopromide, according to the MUSC study, which included U. Joseph Schoepf, M.D., MUSC professor of radiology and leading CT researcher.
Administering contrast medium in patients with kidney disease must consider greater implications. Caution must be exercised in patients with severely impaired renal function, combined renal and hepatic disease, combined renal and cardiac disease, severe thyrotoxicosis, myelomatosis, or anuria, particularly when large doses of the contrast are administered.
The study by a team of physicians and researchers included 117 patients with decreased renal function, defined as SCr (greater than) 1.5 mg/mL or GFR (less than) 60mL/minute. Each patient underwent contrast-enhanced computed-tomography (CT) studies. Sixty-one patients were administered iodixanol, while 56 were administered iopromide. The study measured changes in SCr levels and GFR at plus one, two, and three days post-CT and then monitored outcomes at 30 and 90 days.
Fewer patients who were administered iodixanol showed an SCr increase of 25 percent or greater, 8.5 percent versus 28 percent respectively. No patients in either group showed a contrast media related adverse event at the 30- or 90-day follow-up. A clinically-relevant GFR reduction of 5mL/min was found in significantly more patients in the iopromide group than in the iodixanol group; 42.3 percent versus. 24.1 percent.
The study concluded that while intravenous contrast material application in high-risk patients is unlikely to be associated with permanent adverse outcomes, SCr levels after contrast material administration are lower in the iodixanol group than in the iopromide group.
The authors noted their findings may differ from other recently published studies on the topic.
“Our systematic serial assessment of SCr level and GFR over three days after CM (contrast media) administration may have been more sensitive to detect SCr-level changes compared with the single sampling at a variable interval (48-72 hours) after contrast medium administration in the prior investigation,” the authors wrote. “Considering that in most patients with decreased renal function, the SCr will peak in the first 72 hours after CM administration, multiple measures may provide greater accuracy regarding SCr dynamics.”
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Friday, Aug. 1, 2008
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