Gadolinium-based contrast agents and nephrotoxicity in patients undergoing coronary artery procedures.
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 > or = 2.0 mg/dl and/or clearance < or = 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.
Briguori
Carlo
C
Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy.
Colombo
Antonio
A
Airoldi
Flavio
F
Melzi
Gloria
G
Michev
Iassen
I
Carlino
Mauro
M
Montorfano
Matteo
M
Chieffo
Alaide
A
Bellanca
Raimondo
R
Ricciardelli
Bruno
B
D000368:Aged; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D003404:Creatinine / Q000652:urine; D005260:Female; D019786:Gadolinium DTPA / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced*; D007676:Kidney Failure, Chronic / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D009942:Organometallic Compounds / Q000009:adverse effects*; D010865:Pilot Projects; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014283:Triiodobenzoic Acids / Q000009:adverse effects
D003287:Contrast Media; D009942:Organometallic Compounds; D014283:Triiodobenzoic Acids; C090600:gadobutrol; C064925:gadodiamide; D003404:Creatinine; C044834:iodixanol; D019786:Gadolinium DTPA