title: Gadolinium contrast media are more nephrotoxic than iodine media. The importance of osmolality in direct renal artery injections.
abstract: A study was undertaken of the role of osmotoxicity in gadolinium (Gd) and iodine contrast media (CM) nephrotoxicity in ischemic porcine kidneys. Test solutions: mannitol iso-osmotic to 0.5 M: gadopentetate (1.96 Osm/kg H2O), 0.5 M: gadodiamide (0.78 Osm/kg H2O) and 0.5 M: iohexol (190 mg I/ml, 0.42 Osm/kg H2O). Each solution was injected [3 ml/kg body weight (BW)] into the balloon-occluded (10 min) renal artery of eight left-sided nephrectomized pigs. The plasma half-life of a glomerular filtration rate (GFR) marker was used to compare their effects on GFR 1-3 h post-injection. The median half-lives of the GFR marker after injection of gadopentetate (1,730 min) and mannitol 1.96 Osm/kg H2O (2,782 min) did not differ statistically (P = 0.28), but were significantly longer than after all other solutions (P < 0.001). There was no significant difference (P = 0.06) between gadodiamide (218 min) and mannitol 0.82 Osm/kg H2O (169 min), while there was (P = 0.03) between iohexol (181 min) and mannitol 0.43 Osm/kg H2O (148 min). The difference between gadodiamide and iohexol was significant (P = 0.01). Reduction in GFR, as a marker of nephrotoxicity, induced by gadopentetate correlated with its high osmolality, while the effect of gadodiamide and iohexol may include chemotoxicity. Iohexol molecules were less nephrotoxic than the Gd-CM molecules and contain three-times the number of attenuating atoms per molecule.
authors.affiliation: Department of Diagnostic Radiology, Malmö University Hospital, Lund University, SE-205 02, Malmö, Sweden. barbara.elmstahl@med.lu.se
authors.forename: Barbara
authors.initials: B
authors.lastname: Elmståhl
authors.forename: Ulf
authors.initials: U
authors.lastname: Nyman
authors.forename: Peter
authors.initials: P
authors.lastname: Leander
authors.forename: Chun-Ming
authors.initials: CM
authors.lastname: Chai
authors.forename: Klaes
authors.initials: K
authors.lastname: Golman
authors.forename: Jonas
authors.initials: J
authors.lastname: Björk
authors.forename: Torsten
authors.initials: T
authors.lastname: Almén
mesh_terms: D000818:Animals; D003287:Contrast Media / Q000493:pharmacokinetics / Q000633:toxicity*; D019786:Gadolinium DTPA / Q000493:pharmacokinetics / Q000633:toxicity*; D005919:Glomerular Filtration Rate; D006207:Half-Life; D007267:Injections; D007472:Iohexol / Q000493:pharmacokinetics / Q000633:toxicity*; D007674:Kidney Diseases / Q000139:chemically induced*; D008297:Male; D008353:Mannitol / Q000493:pharmacokinetics / Q000633:toxicity; D009994:Osmolar Concentration; D012077:Renal Artery; D018709:Statistics, Nonparametric; D013552:Swine
chemical_list: D003287:Contrast Media; D008353:Mannitol; D007472:Iohexol; C064925:gadodiamide; D019786:Gadolinium DTPA