Comparison between gadolinium and iodine contrast for percutaneous intervention in atherosclerotic renal artery stenosis: clinical outcomes.
BACKGROUND
Percutaneous angiography with iodinated contrast in patients with chronic kidney disease carries a risk of contrast nephropathy, which is independently associated with renal disease progression and increased mortality. Gadolinium contrast is a potential alternative to iodinated contrast for percutaneous transluminal renal angioplasty (PTRA), and appears to be safe and well tolerated. The aim of this study was to assess the results of gadolinium use to facilitate PTRA in patients with chronic kidney disease.


METHODS
Clinical outcomes were compared between patients with serum creatinine (Cr) >/= 176 micromol/L (2 mg/dL), who had either gadolinium (n = 57; gadoteridol or gadodiamide), iodinated (n = 68; iohexol or iodixanol) or a combination of gadolinium and iodinated-contrast-enhanced (n = 38) PTRA.


RESULTS
Despite similar degrees of pre-procedural renal insufficiency, the incidence of immediate contrast nephropathy [defined as an increase in serum Cr of 44 micromol/L (0.5 mg/dL) within 7 days without other identifiable causes] was lowest in the gadolinium group (3/57, 5.3%) compared to those receiving a combination of modest iodinated contrast in addition to gadolinium (4/38, 10.5%) or solely iodinated contrast (14/68, 20.6%). This was associated with a reduction in the 30-day progression to need for renal replacement therapy (RRT) (P < 0.005). Yet, over a mean follow-up of 40 +/- 22 months, renal function outcomes or all-cause mortality were not different between the contrast groups. The type of contrast used had no effect on technical success and both short- and long-term blood pressure outcomes were comparable between the groups. Two patients developed pathology-proven nephrogenic fibrosing dermopathy, a serious skin condition that has been seen in patients with kidney disease following administration of gadolinium.


CONCLUSIONS
Gadolinium contrast appears to be an effective agent for interventional renal angiograms. Compared to iodinated contrast, gadolinium contrast is associated with a significantly lower incidence of contrast nephropathy and early progression to end-stage renal disease (ESRD) in patients with pre-existing chronic kidney disease. The risk of fibrosing dermopathy however and remains to be established.
Kane
Garvan C
GC
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Stanson
Anthony W
AW
Kalnicka
Dita
D
Rosenthal
David W
DW
Lee
Christine U
CU
Textor
Stephen C
SC
Garovic
Vesna D
VD
D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D000800:Angioplasty, Balloon / Q000379:methods*; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D019786:Gadolinium DTPA / Q000008:administration & dosage / Q000009:adverse effects; D006571:Heterocyclic Compounds / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D007472:Iohexol / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000009:adverse effects; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D051437:Renal Insufficiency / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids / Q000008:administration & dosage / Q000009:adverse effects
D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; D014283:Triiodobenzoic Acids; C062402:gadoteridol; D007472:Iohexol; C064925:gadodiamide; D005682:Gadolinium; D003404:Creatinine; C044834:iodixanol; D019786:Gadolinium DTPA