Efficacy Of Lobitridol And Iopromide On Renal Function In Patients Underwent Coronary Artery Intervention

Background and Objective:The characteristics and dosage of Contrast medium (CM) play a key role in the occurrence and development of contrast induced nephropathy (CIN). Choosing a non-ionic low or iso-osmolality CM, and limiting the contrast volume may be beneficial in patients who undergo CM exposure. However, the differences in the safety of different CMs are still quite unclear. This study was undertaken to compare the efficacy of Iobitridol and Iopromide on renal function in patients underwent coronary artery intervention, which can provide clinical evidence for the adoption of CMs.Methods:This study was conducted in our hospital from January to March this year. Based on the inclusion and exclusion criteria,44 patients(Iopromide group 21 cases, Iobitridol group 23 cases) underwent intervention for diagnosis and treatment of coronary artery disease were enrolled,30 males,14 females, aged between 39 to 76 years old(58.4±9.2 years),21 patients underwent the coronary angiography(CAG), while 23 cases were treated with stent implantation. Before the operation, basic information, including the tests, of the cases were well recorded, such as gender, age, height, weight, complication with hypertension or diabetes, application of ACEI/ARB, blood and urine routine examination, renal function, blood lipid etc. All the patients were treated with conventional hydration and water administration before and after the procedure. The CM volume and procedures were recorded after the operation, and the renal function was reexamined in the 1st and the 3rd day. IfΔScr≥0.25mg/dl, additional renal function would be tested in the 7th day. Our study adopted the simplified MDRD formula to calculate glomerular filtration rate (GFR), and CIN was defined by the diagnostic criteria of guidline from the European Society of Urogenital Radiology (ESUR). In this research, all data were analyzed by statistical software SPSS 16.0. Measurement data (mean±variance) was analyzed by the Student T Test or analysis of variance, while enumeration data (number and percentage) was analyzed by the Chi-square Test or Fisher's exact test. P<0.05 was considered statistically significant.Results:BUN, Scr and GFR values had no statistical significance＞0.05) between the two groups both in the 1st and the 3rd day after the procedure; Compared with the preoperative baseline values, BUN of the 1st and 3rd day decreased significantly(P< 0.01), while Scr and GFR had no significant change(P>0.05); Both in the two groups, BUN, Scr, and GFR values has no significantly differences between the 1st and the 3rd day after the procedure (P> 0.05). According to the ESUR's diagnostic criteria, the cumulative incidence of CIN within three days was 4.35%(1 of 23 cases) in Iobitridol group and 0%(0 of 21 cases) in Iopromide group, and the overall incidence of CIN was 2.27% (1 of 44 cases); SCr increases(ΔScr)>or=0.25 mg/dl(22.1μmol/l) occurred in 39.1%(9 of 23 cases) after Iobitridol exposure and 0%(0 of 21 cases) after Iopromide exposure(Fisher's exact test, P=0.002). Renal function of the 9 cases (including 1 CIN case) restored well in the 7th day, no significant adverse reactions occurred.Conclusions:BUN, Scr and GFR in the 1st and 3rd day after the exposure of CM had no significant difference between Iopromide and Iobitridol group; The cumulative incidence of CIN had no statistical significance between the two groups within three days, however SCr increases(ΔScr)>or=0.25 mg/dl (22.1μmol/l) occurred in more cases(9 of 23 cases) after Iobitridol exposure than after Iopromide exposure(0 of 21 cases), indicating that Iobitridol might have a greater impact on the renal function, which may be related to Iobitridol's osmolality, chemical toxicity, cytotoxicity, immunogenicity and other factors; Renal function of the 9 cases (including 1 CIN case) restored well in the 7th day, no significant adverse reactions occurred, suggesting that the renal damage by Iobitridol could be transient and reversible; Compared with the preoperative baseline values, BUN in the 1st and 3rd day after treating with CM decreased significantly, which might be related to the perioperative hydration therapy.