A comparative study of the nephrotoxicity of iohexol, iopamidol and ioxaglate in peripheral angiography

Iohexol (Omnipaque 350) and iopamidol (Isovue 370) are nonionic monomers; ioxaglate (Hexabrix 320) is an ionic dimer. We compared the nephrotoxicity of these three media by a prospective double-blind evaluation in 500 patients who underwent peripheral angiography during a 6-month period. Serum creatinine levels were determined before injection of the contrast medium and 72 hours after in 478 patients. In 308 (64%) patients there was an average increase in the serum creatinine level of 18.1 μmol/L after injection of an average volume of 123 ml of contrast medium. A subset of 80 patients who had an elevated baseline creatinine level (more than 110 μmol/L) had an average increase in the serum creatinine level of 40.45 μmol/L. Of patients who had arterial injections, 182 (72%) had an increase in serum creatinine levels (20.7 μmol/L), but of those who had peripheral venous injections, only 43% (45%) had an elevated creatinine level (9.2 μmol/L), and of those who had central venous injections, 83 (63.8%) had an elevated level (17.0 μmol/L). In most patients elevation of the serum creatinine level was not of clinical importance. High-risk patients with an elevated serum creatinine level were found to be most vulnerable to contrast nephrotoxicity. Although mean differences were not statistically significant, there were consistent trends which suggested that ioxaglate was the least nephrotoxic of the three agents studied.