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Gadolinium‐based contrast agents and nephrotoxicity in patients undergoing coronary artery procedures
Author(s) -
Briguori Carlo,
Colombo Antonio,
Airoldi Flavio,
Melzi Gloria,
Michev Iassen,
Carlino Mauro,
Montorfano Matteo,
Chieffo Alaide,
Bellanca Raimondo,
Ricciardelli Bruno
Publication year - 2006
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.20592
Subject(s) - medicine , nephrotoxicity , iodinated contrast , gadolinium , creatinine , renal function , urology , saline , contrast medium , dialysis , nuclear medicine , kidney , surgery , radiology , computed tomography , materials science , metallurgy
Objective : We tested whether gadolinium‐based contrast agent is less nephrotoxic than iodinated‐contrast media. Background : Iodinated contrast agents are nephrotoxic. Some data suggest that gadolinium‐based contrast agent may be less nephrotoxic than iodinated‐contrast media. Methods : Twenty‐five consecutive patients with chronic renal insufficiency (creatinine concentration ≥2.0 mg/dl and/or clearance ≤40 ml/min), referred to our institution for coronary procedures, were assigned to receive gadolinium‐based contrast agents, a solution of gadolinium chelates diluted 3:1 by iso‐osmolality contrast media (Gadolinium‐based group). A control group of 32 patients with comparable clinical characteristics and treated with iodinated iso‐osmolality contrast agent alone (Iodinated‐based group) was selected from our database and compared with the Gadolinium‐based group. In all cases, prophylactic administration of 0.45% saline intravenously and NAC (1200 mg orally twice daily) was used. Results : Baseline creatinine levels and creatinine clearance were similar in the 2 groups (Gadolinium‐based group = 2.30 [IQR: 2.01–2.68] mg/dl and 33 ± 13 ml/min; Iodinated‐based group = 2.24 [IQR: 2.05–2.65] mg/dl and 30 ± 10 ml/min; P >0.05 for all). Increase of at least 0.5 mg/dl of the creatinine concentration 48 hr after the procedure occurred in 7/25 (28%) patients in the Gadolinium‐based group and in 2/32 (6.5%) patients in the Iodinated‐based group ( P = 0.034; OR = 4.48; 95% CI = 1.01–19.17). Renal failure requiring temporary dialysis occurred in 2 (8%) patients in the Gadolinium‐based group and in none in the Iodinated‐based group ( P = 0.19). Conclusions : The strategy of gadolinium‐based contrast agent administration does not seem to reduce the rate of CAN, as compared to the iodinated iso‐osmolality contrast agent in patients with chronic renal insufficiency.© 2006 Wiley‐Liss, Inc.