EFFECTS OF A DIMERIC VS A MONOMERIC NONIONIC CONTRAST-MEDIUM ON RENAL-FUNCTION IN PATIENTS WITH MILD-TO-MODERATE RENAL-INSUFFICIENCY - A DOUBLE-BLIND, RANDOMIZED CLINICAL-TRIAL

The efficacy and safety of nonionic dimeric contrast media in subjects with impaired renal function is largely unknown. The present study wa s aimed at determining the risk of tubular nephrotoxicity in patients with mild to moderate renal insufficiency who underwent intravenous ur ography (IVU) with the nonionic dimeric contrast agent iodixanol (Visi paque, Nycomed Imaging, Oslo, Norway). In a double-blind protocol 64 p atients (55 males; mean age 68.3 years) with serum creatinine between 135 and 265 mu mol/l who were to-undergo IVU were randomized to receiv e iodixanol (a nonionic dimer) or iopromide (a nonionic monomer), 600 mg I/kg b.w. Renal function was evaluated before and 1h, 6h, 24h, 48h and 7 days after IVU with analysis of serum creatine, urinary enzymes alanylaminopeptidase and N-acetyl-beta-glucosaminidase, and urinary mi croproteins alpha-1-microglobulin and albumin. Renal function remained , stable in both contrast medium groups during the follow-up period. N o statistically significant differences were observed between the mono mer and the dimer in terms of urinary enzyme and microprotein excretio n or serum creatinine. Transient radiocontrast-induced nephropathy dev eloped in 1 patient who had received iodixanol. The administration of the nonionic dimeric contrast medium iodixanol, or of the nonionic mon omer iopromide, entailed a low nephrotoxic potential in patients with mild to moderate renal insufficiency undergoing excretory urography.