title: Dosing of contrast material to prevent contrast nephropathy in patients with renal disease.
abstract: OBJECTIVE
  Contrast-induced renal dysfunction has been reported to occur in 15% to 42% of patients with underlying azotemia, but there is disagreement as to whether its incidence is reduced by limiting the amount of contrast material. To adjust the amount of contrast material to the severity of azotemia, we have utilized the following formula to calculate a contrast material "limit" in patients with renal disease: Contrast material limit = (formula; see text)
  
  
  METHODS
  Over a 10-year period, 115 patients (53 men, 62 women, aged 61 +/- 11 [mean +/- SD] years) with renal dysfunction (baseline serum creatinine level greater than or equal to 1.8 mg/dL) underwent cardiac catheterization and angiography, after which the level of serum creatinine was measured daily for five days. The amount of contrast material that was given adhered to the limit in 86 patients (Group I) and exceeded it in 29 (Group II).
  
  
  RESULTS
  Contrast-induced renal dysfunction (an increase in serum creatinine greater than or equal to 1.0 mg/dL) occurred in two (2%) patients in Group I and in six (21%) patients in Group II (p less than 0.001). Of the 48 patients with concomitant diabetes mellitus, the contrast limit was surpassed in 16, six (38%) of whom had contrast nephropathy. Only two of the 32 (6%) diabetic patients in whom the contrast limit was not exceeded had contrast nephropathy (p less than 0.001).
  
  
  CONCLUSIONS
  Thus, contrast-induced renal dysfunction occurs infrequently if the amount of contrast material is limited in accordance with the degree of azotemia. Diabetic patients have a high incidence of contrast nephropathy, particularly when they receive an excessive amount of contrast. In patients with diabetes and renal impairment, it may be preferable to perform angiography as a staged procedure or to utilize alternative (non-contrast) techniques to obtain the desired information rather than to exceed the prescribed contrast limit.
authors.affiliation: Department of Internal Medicine (Cardiovascular Division), University of Texas Southwestern Medical Center, Dallas.
authors.forename: R G
authors.initials: RG
authors.lastname: Cigarroa
authors.forename: R A
authors.initials: RA
authors.lastname: Lange
authors.forename: R H
authors.initials: RH
authors.lastname: Williams
authors.forename: L D
authors.initials: LD
authors.lastname: Hillis
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000517:prevention & control; D000792:Angiography / Q000379:methods; D006328:Cardiac Catheterization; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D003928:Diabetic Nephropathies / Q000097:blood / Q000150:complications; D003973:Diatrizoate / Q000008:administration & dosage / Q000009:adverse effects; D003974:Diatrizoate Meglumine / Q000008:administration & dosage / Q000009:adverse effects; D004338:Drug Combinations / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D003287:Contrast Media; D004338:Drug Combinations; D003973:Diatrizoate; D003974:Diatrizoate Meglumine; C027278:urovision; D003404:Creatinine