Skip to main content
SpringerLink
Log in

Iodixanol-associated acute kidney injury and prognosis in patients undergoing elective percutaneous coronary intervention: a prospective, multi-center study

  • Contrast Media
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate iodixanol-associated acute kidney injury (AKI) and prognosis in patients undergoing elective percutaneous coronary intervention (PCI).

Methods

Patients undergoing elective PCI and iodixanol administration were prospectively enrolled in 8 centers between May 2020 and November 2021. The primary endpoint was AKI, defined as an increase in SCr of ≥ 0.3 mg/dL (26.4 μmol/L) or relative elevation ≥ 50% from baseline in the 48–72 h after PCI. Prognosis evaluations included the major adverse renal and cardiovascular events (MARCE): all-cause mortality, new-onset renal replacement therapy (NRRT), non-fatal myocardial infarction, and non-fatal stroke. AKI predictors were identified using multivariable logistic regression and associations between AKI and outcomes were examined using Cox regression.

Results

A total of 3630 patients were included in the final analysis and 2.9% of patients (107/3,630) suffered AKI. Among them, 95.3% (102/107) of AKI were stage 1, and 4.6% (5/107) of stage 2. The multivariable analysis indicated that age over 75-year-old, diabetes, NT-pro-BNP > 300 pg/mL, hemoglobin < 110 g/L, eGFR < 60 mL/min/1.73m2, and diuretics were independently associated with AKI (p < 0.05). After a median follow-up of 13 months, MARCE occurred in 3.6% (131/3630) of the study population, and their incidence was higher in AKI (9.4%, 10/107) vs. non-AKI patients (3.4%, 121/3,523). However, after multivariable adjustment, there was no statistically significant association between AKI and MARCE (p = 0.382).

Conclusions

In patients undergoing elective PCI, cases of iodixanol-associated AKI were mostly mild and, after multivariable adjustment, held no statistically significant association with MARCE on mid-term follow-up.

Clinical relevance statement

The incidence of iodixanol-associated AKI was low and mainly limited to mild renal impairment in patients undergoing elective PCI. Physicians should provide adequate contrast for coronary artery evaluation and, at the same time, minimize the contrast volume.

Key Points

• The incidence of iodixanol-associated acute kidney injury was low and mostly limited to mild renal impairment.

• Iodixanol administration had no statistically significant impact on the major adverse renal and cardiovascular events in patients undergoing elective percutaneous coronary intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

ACEI:

Angiotensin converting enzyme inhibitor

AKI:

Acute kidney injury

ARB:

Angiotensin II receptor blocker

CA-AKI:

Contrast-associated acute kidney injury

CCB :

Calcium channel blockers

CKD :

Chronic kidney disease

eGFR:

Estimated glomerular filtration rate

LVEF:

Left Ventricular Ejection Fraction

MARCE :

Major adverse renal and cardiovascular events

MDRD :

Modification of diet in renal disease

MI :

Non-fatal myocardial infarction

NRRT :

New-renal replacement therapy

NT-Pro-BNP :

N-terminal pro-B-type natriuretic peptide

NYHA:

New York Heart Association

PCI:

Percutaneous coronary intervention

SBP:

Systolic blood pressure

SCr:

Serum creatinine

References

  1. Mehran R, Dangas GD, Weisbord SD (2019) Contrast-associated acute kidney injury. N Engl J Med 380(22):2146–2155

    Article  CAS  PubMed  Google Scholar 

  2. Mohebi R, Karimi Galougahi K, Garcia JJ et al (2022) Long-term clinical impact of contrast-associated acute kidney injury following PCI: an ADAPT-DES substudy. JACC Cardiovasc Interv 15(7):753–766

    Article  PubMed  Google Scholar 

  3. Amsterdam EA, Wenger NK, Brindis RG et al (2014) 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 64(24):e139–e228

    Article  PubMed  Google Scholar 

  4. Lawton JS, Tamis-Holland JE, Bangalore S et al (2022) 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: executive summary: a Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 145(3):e4–e17

    PubMed  Google Scholar 

  5. Barrett BJ, Carlisle EJ (1993) Meta analysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology 188(1):171–178

    Article  CAS  PubMed  Google Scholar 

  6. Azzalini L, Vilca LM, Lombardo F et al (2018) Incidence of contrast-induced acute kidney injury in a large cohort of all-comers undergoing percutaneous coronary intervention: comparison of five contrast media. Int J Cardiol 273:69–73

    Article  PubMed  Google Scholar 

  7. Zhang J, Jiang Y, Rui Q et al (2018) Iodixanol versus iopromide in patients with renal insufficiency undergoing coronary angiography with or without PCI. Medicine (Baltimore) 97(18):e0617

    Article  CAS  PubMed  Google Scholar 

  8. McCullough P, Ng CS, Ryan M, Baker ER, Mehta R (2021) Major adverse renal and cardiovascular events following intra-arterial contrast media administration in hospitalized patients with comorbid conditions. Cardiorenal Med 11(4):193–199

    Article  CAS  PubMed  Google Scholar 

  9. Du M, Jiang L, Tang X, Gao Z, Xu B, Yuan J (2021) Contrast induced nephropathy and 2-year outcomes of iso-osmolar compared with low-osmolar contrast media after elective percutaneous coronary intervention. Korean Circ J 51(2):174–181

    Article  CAS  PubMed  Google Scholar 

  10. Wi J, Ko YG, Kim JS et al (2011) Impact of contrast-induced acute kidney injury with transient or persistent renal dysfunction on long-term outcomes of patients with acute myocardial infarction undergoing percutaneous coronary intervention. Heart 97(21):1753–1757

    Article  PubMed  Google Scholar 

  11. Helgason D, Long TE, Helgadottir S et al (2018) Acute kidney injury following coronary angiography: a nationwide study of incidence, risk factors and long-term outcomes. J Nephrol 31(5):721–730

    Article  PubMed  Google Scholar 

  12. Maioli M, Toso A, Leoncini M, Gallopin M, Musilli N, Bellandi F (2012) Persistent renal damage after contrast-induced acute kidney injury: incidence, evolution, risk factors, and prognosis. Circulation 125(25):3099–3107

    Article  PubMed  Google Scholar 

  13. Zhao N, Chen Z, Zhou Y et al (2021) Effects of a high dose of the contrast medium iodixanol on renal function in patients following percutaneous coronary intervention. Angiology 72(2):145–152

    Article  CAS  PubMed  Google Scholar 

  14. Levine GN, Bates ER, Blankenship JC et al (2011) 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 124(23):e574-651

    PubMed  Google Scholar 

  15. van der Molen AJ, Reimer P, Dekkers IA et al (2018) Post-contrast acute kidney injury - Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors: recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 28(7):2845–2855

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sparrow HG, Swan JT, Moore LW, Gaber AO, Suki WN (2019) Disparate outcomes observed within Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury stage 1. Kidney Int 95(4):905–913

    Article  PubMed  Google Scholar 

  17. Mehta RL, Kellum JA, Shah SV et al (2007) Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11(2):R31

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ma YC, Zuo L, Chen JH et al (2006) Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol 17(10):2937–2944

    Article  PubMed  Google Scholar 

  19. Kopin L, Lowenstein C (2017) Dyslipidemia. Ann Intern Med 167(11):ITC81-ITC96

  20. Mehran R, Aymong ED, Nikolsky E et al (2004) A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 44(7):1393–1399

    PubMed  Google Scholar 

  21. Mo H, Ye F, Chen D et al (2021) A predictive model based on a new CI-AKI definition to predict contrast induced nephropathy in patients with coronary artery disease with relatively normal renal function. Front Cardiovasc Med 8:762576

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Weisbord SD, Palevsky PM, Kaufman JS et al (2020) Contrast-associated acute kidney injury and serious adverse outcomes following angiography. J Am Coll Cardiol 75(11):1311–1320

    Article  PubMed  Google Scholar 

  23. Mehran R, Nikolsky E, Kirtane AJ et al (2009) Ionic low-osmolar versus nonionic iso-osmolar contrast media to obviate worsening nephropathy after angioplasty in chronic renal failure patients: the ICON (Ionic versus non-ionic Contrast to Obviate worsening Nephropathy after angioplasty in chronic renal failure patients) study. JACC Cardiovasc Interv 2(5):415–421

    Article  PubMed  Google Scholar 

  24. Ricci Z, Cruz DN, Ronco C (2011) Classification and staging of acute kidney injury: beyond the RIFLE and AKIN criteria. Nat Rev Nephrol 7(4):201–208

    Article  CAS  PubMed  Google Scholar 

  25. Amin AP, Bach RG, Caruso ML, Kennedy KF, Spertus JA (2017) association of variation in contrast volume with acute kidney injury in patients undergoing percutaneous coronary intervention. JAMA Cardiol 2(9):1007–1012

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tsai TT, Patel UD, Chang TI et al (2014) Validated contemporary risk model of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the National Cardiovascular Data Registry Cath-PCI Registry. J Am Heart Assoc 3(6):e001380

    Article  PubMed  PubMed Central  Google Scholar 

  27. Tsai TT, Patel UD, Chang TI et al (2014) Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv 7(1):1–9

    Article  PubMed  PubMed Central  Google Scholar 

  28. Gessolo Lins PR, Carvalho Padilha WS, Magalhaes Giradin Pimentel CF, Costa Batista M, Teixeira de Gois AF (2018) Risk factors, mortality and acute kidney injury outcomes in cirrhotic patients in the emergency department. BMC Nephrol 19(1):277

    Article  PubMed  PubMed Central  Google Scholar 

  29. Cigarroa R, Lange RA, Williams RH, Hillis LD (1989) Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med 86:649–652

    Article  CAS  PubMed  Google Scholar 

  30. Brown JR, Robb JF, Block CA et al (2010) Does safe dosing of iodinated contrast prevent contrast-induced acute kidney injury? Circ Cardiovasc Interv 3(4):346–350

    Article  PubMed  PubMed Central  Google Scholar 

  31. Freeman RV, O’Donnell M, Share D et al (2002) Nephropathy requiring dialysis after percu- taneous coronary intervention and the critical role of an adjusted contrast dose. Am J Cardiol. 90:1068–1073

    Article  PubMed  Google Scholar 

  32. Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS), European Association for Percutaneous Cardiovascular Interventions (EAPCI), Wijns W et al (2010) Guidelines on myocardial revascularization. Eur Heart J 31(20):2501–55

  33. Galassi AR, Werner GS, Boukhris M et al (2019) Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club. EuroIntervention 15(2):198–208

    Article  PubMed  Google Scholar 

  34. Azzalini L, Spagnoli V, Ly HQ (2016) Contrast-Induced Nephropathy: From Pathophysiology to Preventive Strategies. Can J Cardiol 32(2):247–255

    Article  PubMed  Google Scholar 

  35. Nayak KR, Mehta HS, Price MJ et al (2010) A novel technique for ultra-low contrast administration during angiography or intervention. Catheter Cardiovasc Interv 75:1076–1083

    Article  PubMed  Google Scholar 

  36. Mehran R, Nikolsky E (2006) Contrast-induced nephropathy: Definition, epidemiology, and patients at risk. Kidney Int Suppl 100:S11–S15

    Article  CAS  Google Scholar 

  37. Mehran R, Owen R, Chiarito M et al (2021) A contemporary simple risk score for prediction of contrast-associated acute kidney injury after percutaneous coronary intervention: derivation and validation from an observational registry. Lancet 398(10315):1974–1983

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledged all the researchers enrolled in this study. We appreciated Prof. Rufu Xu from Xinqiao Hospital for his support in statistical analysis.

Funding

This study has received funding by the National Natural Science Foundation of China (81670428) and the Technical Innovation & Application Development Special Project from Chongqing City (cstc2019jscx-msxmX0128).

Author information

Author notes

  1. Zaiyan Chen and Qi Mao contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China

    Zaiyan Chen, Qi Mao, Li Xiang, Denglu Zhou, Yanbing Jiang, Lan Huang & Xiaohui Zhao

  2. Department of Cardiovascular Diseases, The General Hospital of Tibet Military Region, Lhasa, China

    Ning Zhao

  3. Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA

    Lorenzo Azzalini

Authors
  1. Zaiyan Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qi Mao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Li Xiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Denglu Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yanbing Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ning Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lan Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lorenzo Azzalini
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Xiaohui Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Lorenzo Azzalini or Xiaohui Zhao.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Xiaohui Zhao, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China.

Conflict of interest

Dr. Azzalini has received consulting fees from Teleflex, Abiomed, GE Healthcare, Asahi Intec, Philips, Abbott Vascular, and Cardiovascular Systems, Inc. All Other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Study subjects have never been reported before.

Methodology

  • prospective

  • diagnostic or prognostic study

  • multicenter study

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 284 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, Z., Mao, Q., Xiang, L. et al. Iodixanol-associated acute kidney injury and prognosis in patients undergoing elective percutaneous coronary intervention: a prospective, multi-center study. Eur Radiol 33, 9444–9454 (2023). https://doi.org/10.1007/s00330-023-09964-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-023-09964-8

Keywords

Search

Navigation