Renal effects of CO2 and iodinated contrast media in patients undergoing renovascular intervention: a prospective, randomized study.
OBJECTIVE
CO2 gas has been proposed for use instead of iodinated contrast media in angiographic examinations in patients at risk of developing renal failure from contrast media. The influence of intraarterial injection of CO2 with small added amounts of ioxaglate (200 mgI/mL) or ioxaglate alone on renal function in patients with suspected renal artery stenosis was studied in a prospective, randomized study.


METHODS
One hundred twenty-three patients underwent renovascular intervention (n = 83) and/or renal angiography (n = 40) for suspected renal artery stenosis. Patients with a serum creatinine concentration less than 200 micromol/L (n = 82) were randomized prospectively to receive CO2 with small added amounts of ioxaglate (n = 37) or only ioxaglate (n = 45). Patients with serum creatinine levels greater than 200 micromol/L (n = 41) were not randomized and initially received CO2. Serum creatinine concentrations were measured within 1 day before and 1 day, 2 days, and 2-3 weeks after the procedure.


RESULTS
The amount of injected CO2 did not relate to an increase in serum creatinine level. In the randomized groups, and also when the whole patient sample was considered, the amount of injected iodine was significantly correlated (P = .011) with an increase in serum creatinine level and a decrease in estimated creatinine clearance after 2 days. Among the randomized patients, one in the CO2 group and three in the ioxaglate group had a more than 25% increase in serum creatinine level within the first 2 days after the intervention.


CONCLUSIONS
The risk of impairment of renal function is lower after injection of CO2 with small amounts of added ioxaglate compared with injection of a larger amount of ioxaglate alone. The larger the amount of administered iodinated contrast medium, the greater the risk of development of renal failure.
Liss
Per
P
Department of Radiology, Uppsala University, Uppsala, Sweden. per.liss@akademiska.se
Eklöf
Hampus
H
Hellberg
Olof
O
Hägg
Anders
A
Boström-Ardin
Annika
A
Löfberg
Anne-Marie
AM
Olsson
Ulf
U
Orndahl
Per
P
Nilsson
Helena
H
Hansell
Peter
P
Eriksson
Lars-Gunnar
LG
Bergqvist
David
D
Nyman
Richard
R
D058186:Acute Kidney Injury / Q000517:prevention & control; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002245:Carbon Dioxide / Q000008:administration & dosage* / Q000009:adverse effects; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D007485:Ioxaglic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012077:Renal Artery / Q000000981:diagnostic imaging; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging*
D003287:Contrast Media; D002245:Carbon Dioxide; D003404:Creatinine; D007485:Ioxaglic Acid