Nephrotoxicity of iodixanol versus ioversol in patients with chronic kidney disease: The Visipaque Angiography/Interventions with Laboratory Outcomes in Renal Insufficiency (VALOR) Trial

Background: Iso-osmolar contrast medium iodixanol has been reported to be less nephrotoxic than selected low-osmolar contrast media (LOCM) in chronic kidney disease (CKD) patients with diabetes mellitus. This study compared the nephrotoxicity of iodixanol and the LOCM ioversol in CKD patients undergoing coronary angiography. Methods: This is a prospective double-blind trial in 337 patients with stable CKD who were randomly assigned to receive the iso-osmolar contrast medium iodixanol or the LOCM ioversol. The co-primary end points were the mean peak percentage change (MPPC) in baseline serum creatinine and the incidence of contrast-induced nephropathy (rise of >0.5 mg/dL in baseline serum creatinine within 72 hours postcontrast) for the 2 contrast media in the 72-hour period after contrast administration. Prespecified analyses included stratification on diabetic state and the use of N-acetylcysteine. Results: In the 299 patients with complete post-contrast media creatinine data, the incidence of contrast-induced nephropathy was 21.8% in the iodixanol subjects and 23.8% in the ioversol subjects (P = .78). For all patients, the MPPC was 14.7% with iodixanol and 20.0% with ioversol (P = .06), whereas in the subset of diabetic patients, this value was significantly lower in the iodixanol (12.9%) compared with the ioversol subjects (22.4%, P = .01). Conclusions: Overall, the nephrotoxicity associated with iodixanol was not significantly different from that observed with ioversol in CKD patients undergoing coronary angiography, although in diabetic patients, MPPC was significantly lower in the iodixanol group.