Does gadolinium-based angiography protect against contrast-induced nephropathy?: a systematic review of the literature.
We evaluated the incidence of contrast-induced nephropathy (CIN) in patients exposed to gadolinium for diagnostic or therapeutic procedures.


BACKGROUND
CIN with iodinated contrast agents is a leading cause of acute renal failure. Gadolinium is often used as an alternative to iodinated contrast in patients at increased risk of CIN. The safety of gadolinium in patients at increased risk of CIN has not been established.


RESULTS
The authors performed a systematic review by searching MEDLINE, ISI Web of Knowledge, Current Contents, Embase, and the Cochrane Central Register of Controlled Trials to identify relevant studies evaluating gadolinium and its associated incidence of CIN. They identified 17 studies that reported both favorable and negative results with regard to the association of gadolinium and CIN. The differences in the results appeared to be dose related. When gadolinium was used in doses of 0.4 mmol/kg or higher, there appeared to be an increased incidence of ARF particularly in patients with preexisting renal insufficiency.


CONCLUSIONS
Although the evidence base is limited, gadolinium does not appear to be safer than iodinated contrast in patients at risk of CIN. Given the lack of randomized data to support its safety, gadolinium in lieu of iso-osmolar iodinated contrast cannot be advocated in patients at high risk of contrast nephropathy.
Boyden
Thomas F
TF
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan 48109-5853, USA.
Gurm
Hitinder S
HS
D000792:Angiography / Q000379:methods*; D003287:Contrast Media / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D019317:Evidence-Based Medicine; D005682:Gadolinium / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D017613:Iodine Compounds / Q000009:adverse effects*; D018579:Patient Selection; D051437:Renal Insufficiency / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors
D003287:Contrast Media; D017613:Iodine Compounds; D005682:Gadolinium