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J Cell Physiol. 2018 Mar;233(3):2572-2580. doi: 10.1002/jcp.26132. Epub 2017 Sep 12.

Iodixanol versus iopromide in cancer patients: Evidence from a randomized clinical trial.

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Biostatistic Unit, Regina Elena National Cancer Institute, Rome, Italy.
Service of Pharmacovigilance, Regina Elena National Cancer Institute, Rome, Italy.
AUSL di Bologna, Bologna, Italy.
Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy.
Department of Diagnostic Imaging, Regina Elena National Cancer Institute, Rome, Italy.
Department of Diagnostic Imaging, Radiant and Metabolic Therapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy.
Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milan, Italy.
Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy.
Diagnostic Imaging and Senology, IRCCS-A.O.U., San Martino-IST, Genoa, Italy.
Departement of Clinical Patology, Regina Elena National Cancer Institute, Rome, Italy.
Department of Medicine, Surgery and Neuroscience, University of Siena and Istituto Toscano Tumori (ITT), Siena, Italy.
Department of Biology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, Pennsylvania.
Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy.


To assess the safety profile of iso-osmolar contrast medium (CM) versus low osmolar CM in cancer patients with an estimated glomerular filtration rate (eGFR) >60 ml/min. In this multicenter, blind trial of patients seeking a chest-abdomen-pelvis contrast enhanced computed tomography (CT) with iodated CM, participants were centrally randomized to iodixanol or iopromide. Contrast induced nephropathy (CIN) at 24 and/or 72 hr were our primary outcomes. We further considered irreversible CIN, average eGFR percentage variation (%Δ), and adverse events (AEs). Overall, 607 patients were enrolled. Among them, 497 eligible patients were randomized to iodixanol (N: 247) or iopromide (N: 250). No differences emerged by descriptive characteristics. Seven and 3 CIN at 24 hr (p = 0.34) and 8 and 2 CIN at 72 hr (p = 0.11) occurred in the iopromide and iodixanol group, respectively. Within the subgroup of individual patients who developed CIN (N: 17), the event rate was higher in the iopromide arm (p = 0.045). No cases of permanent CIN or significant differences in terms of AEs or GFR %Δ were observed. Our results suggest a more favorable safety profile of iodixanol versus iopromide. Adequately sized trials with similar design are warranted to confirm our findings and clarify the underlying biological mechanisms.


cancer patients; contrast induced nephropathy; low-osmolar/iso-osmolar contrast medium

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