• Richard J Solomon, Roxana Mehran, Madhu K Natarajan, Serge Doucet, Richard E Katholi, Cezar S Staniloae, Samin K Sharma, Marino Labinaz, Joseph L Gelormini, and Brendan J Barrett.
• Department of Renal Services, Fletcher Allen Health Care, Burlington, VT 05401, USA. richard.solomon@vtmednet.org
• Clin J Am Soc Nephrol. 2009 Jul 1; 4 (7): 1162-9.

Background And ObjectivesThe relationship of contrast-induced nephropathy (CIN) to long-term adverse events (AEs) is controversial. Although an association with AEs has been previously reported, it is unclear whether CIN is causally related to these AEs.Design, Setting, Participants, & MeasurementsWe obtained long-term (> or =1 yr) follow-up on 294 patients who participated in a randomized, double-blind comparison of two prevention strategies for CIN (iopamidol versus iodixanol). A difference in the incidence of AEs between patients who had developed CIN and those who had not was performed using a chi(2) test and Poisson regression analysis. A similar statistical approach was used for the differences in AEs between those who received iopamidol or iodixanol. Multiple definitions of CIN were used to strengthen and validate the results and conclusions.ResultsThe rate of long-term AEs was higher in individuals with CIN (all definitions of CIN). After adjustment for baseline comorbidities and risk factors, the adjusted incidence rate ratio for AEs was twice as high in those with CIN. Randomization to iopamidol reduced both the incidence of CIN and AEs.ConclusionsThe parallel decrease in the incidence of CIN and AEs in one arm of this randomized trial supports a causal role for CIN.

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