AKI More Likely After Intracoronary Versus IV Contrast Delivery
In a phase 3 trial, acute kidney injury developed in 13.2% of patients undergoing invasive coronary angiography compared with 5.6% of those undergoing computed tomography angiography.
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NEW ORLEANS--Acute kidney injury (AKI) appears less common following intravenous (IV) versus intracoronary administration of contrast agents, according to Marc Dewey, MD, of Charité-Universitätsmedizin Berlin in Berlin, Germany, who reported late-breaking trial results at Kidney Week 2017.
For the phase 3 trial, Dr Dewey and colleagues randomly assigned patients with chest pain and a suspicion of coronary artery disease to undergo invasive coronary angiography with intracoronary contrast (162 patients) or coronary computed tomography angiography with IV contrast (165 patients). All patients received the same low-osmolar, non-ionic agent.
Contrast-induced AKI (defined as an increase in serum creatinine of 0.5 mg/dL or 25% or more within 2 days) developed in 21 invasive angiography patients (13.2%), but just 9 non-invasive angiography patients (5.6%).
Longer-term data suggested that such AKI led to chronic renal impairment. Estimated glomerular filtration rates did not differ significantly between groups at baseline (84.3 vs 87.1 mL/min/1.73 m2 for the non-invasive and invasive angiography groups, respectively), but after a median 1.9 years, 38% of patients with contrast-induced AKI still had elevated serum creatinine compared with 6% of patients without contrast-induced AKI.
Dr Dewey added that future trials need to be conducted in other populations to better understand the phenomenon.
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1. Dewey M, Bosserdt M, Zimmermann E, et al. Kidney injury after intravenous or intracoronary contrast agents for non-invasive or invasive coronary angiography. Presented at Kidney Week 2017 in New Orleans (Oct. 31 to Nov. 5). Late-breaking abstract.