Gadolinium as an alternative contrast agent for diagnostic and interventional angiographic procedures in patients with impaired renal function.
BACKGROUND
The study was designed to investigate the safety and feasibility of gadopentetate dimeglumine, a gadolinium-based contrast medium, as an alternative angiographic contrast agent in patients with impaired renal function and high risk for iodinated contrast-induced nephropathy.


METHODS
Gadopentetate dimeglumine was used as the radiographic contrast agent in 32 diagnostic or interventional angiographic procedures in 29 patients (59% diabetics) with severe renal insufficiency (average serum creatinine of 3.6+/-1.4 mg/dl). The average dose of gadopentetate dimeglumine was 0.34+/-0.06 mmol/kg body weight. Gadopentetate dimeglumine was used either alone (n=20) or in conjunction with carbon dioxide (n=12).


RESULTS
Thirty-two angiographic procedures (24 diagnostic angiographies and 8 interventional procedures) were performed in 29 patients. For diagnostic purposes, eleven selective renal arteriographies, six angiographies of the iliac arteries and lower extremities, and seven venous angiographies of the upper extremity and central veins were performed. Interventional procedures consisted of two percutaneous transluminal renal angioplasties with stenting, four percutaneous peripheral vascular interventions, and two balloon angioplasties of a dialysis fistula. None of the patients, except one, had evidence of post-procedure contrast material-induced renal failure (increase in serum creatinine >0.5 mg/dl within 72 h) or other complications. This patient had a clinically important increase in serum creatinine level after percutaneous transluminal renal angioplasty and stenting, probably due to cholesterol embolism. Gadopentetate dimeglumine had sufficient radiographic density to allow adequate diagnostic visualization with digital subtraction equipment in all cases.


CONCLUSIONS
Gadopentetate dimeglumine is an alternative and safe radiographic contrast agent for angiography and interventional procedures in patients with severe pre-existing renal impairment. In this population with high risk for contrast-induced acute renal failure, it is obviously less nephrotoxic than iodinated contrast media.
Rieger
Johannes
J
Department of Radiology, Medizinische Klinik - Innenstadt, Ludwig-Maximilians-University, Munich, Germany. jrieger@radin.med.uni-muenchen.de
Sitter
Thomas
T
Toepfer
Marcel
M
Linsenmaier
Ulrich
U
Pfeifer
Klaus Jürgen
KJ
Schiffl
Helmut
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000800:Angioplasty, Balloon; D003287:Contrast Media; D003404:Creatinine / Q000097:blood; D005260:Female; D005682:Gadolinium; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012449:Safety
D003287:Contrast Media; D005682:Gadolinium; D003404:Creatinine