This Article Full Text Full Text (PDF) All Versions of this Article: 115/25/3189    most recent CIRCULATIONAHA.106.671644v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Solomon, R. J. Search for Related Content PubMed PubMed Citation Articles by Solomon, R. J. Related Collections Acute coronary syndromes Catheter-based coronary and valvular interventions: other Coronary imaging: angiography/ultrasound/Doppler/CC Related Article

(Circulation. 2007;115:3189-3196.)
© 2007 American Heart Association, Inc.

Interventional Cardiology

Cardiac Angiography in Renally Impaired Patients (CARE) Study

A Randomized Double-Blind Trial of Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease

Richard J. Solomon, MD; Madhu K. Natarajan, MD; Serge Doucet, MD; Samin K. Sharma, MD; Cezar S. Staniloae, MD; Richard E. Katholi, MD; Joseph L. Gelormini, MD; Marino Labinaz, MD; Abel E. Moreyra, MD; the Investigators of the CARE Study

From the Department of Renal Services (R.J.S.), Fletcher Allen Health Care, Burlington, Vt.; Division of Cardiology (M.K.N.), Hamilton Health Sciences General Division, Hamilton, Ontario, Canada; Department of Medicine (S.D.), Montreal Heart Institute, University of Montreal, Quebec, Canada; Cardiovascular Institute (S.K.S.), Mount Sinai Medical Center, New York, NY; Comprehensive Cardiovascular Center (C.S.S.), St. Vincent’s Medical Center Manhattan, New York, NY; Department of Medicine (R.E.K.), Southern Illinois University, Springfield; Interventional Cardiology (J.L.G.), Buffalo Heart Group, Buffalo, NY; Department of Medicine (M.L.), Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Medicine (A.E.M.), Division of Cardiology, Robert Wood Johnson Medical School, New Brunswick, NJ.

Correspondence to Richard J. Solomon, MD, Fletcher Allen Health Care, University of Vermont, UHC 2309, 1 South Prospect St, Burlington, VT 05401. E-mail richard.solomon{at}vtmednet.org

Received September 19, 2006; accepted April 30, 2007.

Background— No direct comparisons exist of the renal tolerability of the low-osmolality contrast medium iopamidol with that of the iso-osmolality contrast medium iodixanol in high-risk patients.

Methods and Results— The present study is a multicenter, randomized, double-blind comparison of iopamidol and iodixanol in patients with chronic kidney disease (estimated glomerular filtration rate, 20 to 59 mL/min) who underwent cardiac angiography or percutaneous coronary interventions. Serum creatinine (SCr) levels and estimated glomerular filtration rate were assessed at baseline and 2 to 5 days after receiving medications. The primary outcome was a postdose SCr increase 0.5 mg/dL (44.2 µmol/L) over baseline. Secondary outcomes were a postdose SCr increase 25%, a postdose estimated glomerular filtration rate decrease of 25%, and the mean peak change in SCr. In 414 patients, contrast volume, presence of diabetes mellitus, use of N-acetylcysteine, mean baseline SCr, and estimated glomerular filtration rate were comparable in the 2 groups. SCr increases 0.5 mg/dL occurred in 4.4% (9 of 204 patients) after iopamidol and 6.7% (14 of 210 patients) after iodixanol (P=0.39), whereas rates of SCr increases 25% were 9.8% and 12.4%, respectively (P=0.44). In patients with diabetes, SCr increases 0.5 mg/dL were 5.1% (4 of 78 patients) with iopamidol and 13.0% (12 of 92 patients) with iodixanol (P=0.11), whereas SCr increases 25% were 10.3% and 15.2%, respectively (P=0.37). Mean post-SCr increases were significantly less with iopamidol (all patients: 0.07 versus 0.12 mg/dL, 6.2 versus 10.6 µmol/L, P=0.03; patients with diabetes: 0.07 versus 0.16 mg/dL, 6.2 versus 14.1 µmol/L, P=0.01).

Conclusions— The rate of contrast-induced nephropathy, defined by multiple end points, is not statistically different after the intraarterial administration of iopamidol or iodixanol to high-risk patients, with or without diabetes mellitus. Any true difference between the agents is small and not likely to be clinically significant.

---

 

CLINICAL PERSPECTIVE

Related Article:

Issue Highlights
Circulation 2007 115: 3139. [Full Text]

This article has been cited by other articles:

				M. Kimmel and D. M. Alscher Reply Nephrol. Dial. Transplant., July 1, 2008; 23(7): 2424 - 2425. [Full Text] [PDF]

				M. J. Kuhn, N. Chen, D. V. Sahani, D. Reimer, E. J. R. van Beek, J. P. Heiken, and G. J. So The PREDICT Study: A Randomized Double-Blind Comparison of Contrast-Induced Nephropathy After Low- or Isoosmolar Contrast Agent Exposure Am. J. Roentgenol., July 1, 2008; 191(1): 151 - 157. [Abstract] [Full Text] [PDF]

				S. A. Nguyen, P. Suranyi, J. G. Ravenel, P. K. Randall, P. B. Romano, K. A. Strom, P. Costello, and U. J. Schoepf Iso-Osmolality versus Low-Osmolality Iodinated Contrast Medium at Intravenous Contrast-enhanced CT: Effect on Kidney Function Radiology, July 1, 2008; 248(1): 97 - 105. [Abstract] [Full Text] [PDF]

				S. D. Weisbord, M. K. Mor, A. L. Resnick, K. C. Hartwig, A. F. Sonel, M. J. Fine, and P. M. Palevsky Prevention, Incidence, and Outcomes of Contrast-Induced Acute Kidney Injury Arch Intern Med, June 23, 2008; 168(12): 1325 - 1332. [Abstract] [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The year in interventional cardiology. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2355 - 2369. [Full Text] [PDF]

				P. A. McCullough Contrast-Induced Acute Kidney Injury J. Am. Coll. Cardiol., April 15, 2008; 51(15): 1419 - 1428. [Abstract] [Full Text] [PDF]

				M. Kimmel, M. Butscheid, S. Brenner, U. Kuhlmann, U. Klotz, and D. M. Alscher 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., April 1, 2008; 23(4): 1241 - 1245. [Abstract] [Full Text] [PDF]

				F. Locatelli Letter Regarding Article by Solomon et al, "Cardiac Angiography in REnally Impaired Patients (CARE) Study: A Randomized Double-Blind Trial of Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease" Circulation, February 19, 2008; 117(7): e165 - e165. [Full Text] [PDF]

				M. Anselmino, G. Biondi-Zoccai, and I. Sheiban Letter Regarding Article by Solomon et al, "Cardiac Angiography in REnally Impaired Patients (CARE) Study: A Randomized Double-Blind Trial of Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease" Circulation, February 19, 2008; 117(7): e166 - e166. [Full Text] [PDF]

				R. J. Solomon, M. K. Natarajan, S. Doucet, S. K. Sharma, C. S. Staniloae, R. E. Katholi, J. L. Gelormini, M. Labinaz, and A. E. Moreyra Response to Letters Regarding Article, "Cardiac Angiography in REnally Impaired Patients (CARE) Study: A Randomized Double-Blind Trial of Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease" Circulation, February 19, 2008; 117(7): e167 - e167. [Full Text] [PDF]

				C. A. Herzog Kidney disease in cardiology Nephrol. Dial. Transplant., January 1, 2008; 23(1): 42 - 46. [Abstract] [Full Text] [PDF]