Comparison of the usefulness of gadodiamide and iodine mixture versus iodinated contrast alone for prevention of contrast-induced nephropathy in patients with chronic kidney disease undergoing coronary angiography.
Contrast-induced nephropathy (CIN) is a common cause of hospital-acquired renal failure. Gadolinium-based contrast agents have been proposed as alternatives to iodinated contrast in patients at high risk for CIN. The use of high-dose intraarterial gadolinium chelates in the catheterization laboratory has been investigated in only a small number of patients. We compared patients with a creatinine clearance <60 ml/min/1.73 m2 who received intravenous hydration (> or =1,500 ml) and oral n-acetylcysteine prophylaxis with those who received a gadodiamide-iodine mixture (n = 90) or iodinated contrast alone (n = 79) in the cardiac catheterization laboratory. CIN was defined as an increase of 0.5 mg/dl in serum creatine from baseline. The 2 groups were similar with respect to demographics and risk factors. Although less iodinated contrast was used in the gadolinium mixture group, there was no difference in the incidence of CIN between the 2 groups. However, the initiation of dialysis (n = 7) and death (n = 8) only occurred in the diluted gadolinium contrast group. A stepdown multivariate analysis found diabetes mellitus to be the only independent predictor of CIN (p = 0.02, odds ratio 3.35, 95% confidence interval 1.21 to 9.29, c-statistic 0.66). In conclusion, the incidence of CIN was not decreased in high-risk patients receiving a gadolinium-iodinated contrast mixture versus iodinated contrast alone.
Reed
Pamela S
PS
Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA. psrpsrpsr@aol.com
Dixon
Simon R
SR
Boura
Judith A
JA
O'Neill
William W
WW
Kahn
Joel K
JK
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D005260:Female; D019786:Gadolinium DTPA / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007472:Iohexol / Q000009:adverse effects; D007485:Ioxaglic Acid / Q000009:adverse effects; D007674:Kidney Diseases / Q000139:chemically induced* / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014283:Triiodobenzoic Acids / Q000009:adverse effects
D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; C064925:gadodiamide; C044834:iodixanol; D019786:Gadolinium DTPA; D007485:Ioxaglic Acid