NDT Advance Access originally published online on April 29, 2008
Nephrology Dialysis Transplantation 2008 23(7):2424-2425; doi:10.1093/ndt/gfn166
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Reply
Correspondence and offprint requests to: E-mail: vm.kimmel{at}t-online.deSir,
In the part of our paper mentioned by Jo et al., we are not explaining the rationale for using low-osmolar contrast agent [1]. Our study was designed before the publication of the NEPHRIC trial (n = 129 patients), which shows a smaller incidence of contrast-induced nephropathy by using iso-osmolar contrast media [2]. However, we also have not changed our routine daily clinical approach in 2008 by using the low-osmolar contrast media, because the published results were conflicting in the last 2 years.
In our paper, we emphasized these conflicting results concerning the value of the osmolality of a contrast media (iso-osmolar versus low-osmolar) in preventing contrast-induced nephropathy by citing three recent trials (RECOVER with n = 300 patients published in 2006, IMPACT with n = 166 patients published in 2006 and CARE with n = 414 patients published in 2007).
It was described by the authors of the RECOVER trial, Jo et al., that they indeed found a benefit regarding the composite end-point. Regarding the end-point defined by Aspelin et al. in the NEPHRIC trial, no benefit of the iso-osmolar contrast media could be demonstrated [3].
In the IMPACT and the CARE trial there were no different rates of contrast-induced nephropathy by the use of low- versus iso-osmolar contrast media [4,5]. The CARE trial is the most recent and largest, prospective, randomized double-blind trial comparing the iso-osmolar iodixanol-370 with the low-osmolar iodixanol-320: when a composite end-point was assessed, the rate of contrast-induced nephropathy was not significantly different (10.3% versus 12.9%) after the administration of the different contrast media [5].
From our point of view, the results are so conflicting that there is no evidence of the superiority of the iso-osmolar versus the low-osmolar contrast media and no firm recommendation based on the overwhelming majority of evidences can be made.
Conflict of interest statement. None declared.
Robert-Bosch-Hospital Auerbachstr. 110, D-70376 Stuttgart, Germany
References
- Kimmel M, Butscheid M, Brenner S, et al. Improved estimation of glomerular filtration rate by serum cystatin C in preventing contrast induced nephropathy by N-acetylcysteine or zinc—preliminary results. Nephrol Dial Transplant (2008) 23:1241–1245.
[Abstract/Free Full Text] - Aspelin P, Aubry P, Fransson S, et al. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med (2003) 348:491–499.
[Abstract/Free Full Text] - Jo S, Youn TJ, Koo BW, et al. Renal toxicity evaluation and comparison between visipaque (iodixanol) and hexabrix (ioxaglate) in patients with renal insufficiency undergoing coronary angiography: the RECOVER study: a randomized controlled trial. J Am Coll Cardiol (2006) 48:924–930.
[Abstract/Free Full Text] - Barrett BJ, Katzberg RW, Thomson HS, et al. Contrast-induced nephropathy in patients with chronic kidney disease undergoing computed tomography: a double-blind comparison of iodixanol and iopamidol. Invest Radiol (2006) 41:815–821.[CrossRef][Web of Science][Medline]
- Solomon R, Natarajan MK, Doucet S, et al. The CARE (Cardiac Angiography in REnally Impaired Patients) study: a randomized, double blind trial of contrast-induced nephropathy in high risk patients. Circulation (2007) 115:3189–3196.
[Abstract/Free Full Text]
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