title: High incidence of nephropathy in neurosurgical patients after intra-arterial administration of low-osmolar and iso-osmolar contrast media.
abstract: BACKGROUND
  Percutaneous endovascular examinations and interventions require significant amounts of iodinated contrast media (CM) and have been reported to be complicated by an increased incidence of post-contrast nephropathy.
  
  
  OBJECTIVE
  To evaluate renal function, the incidence of post-contrast nephropathy, and risk factors after interventional procedures in neurosurgical patients after intra-arterial administration of a low-osmolar contrast medium (LOCM) versus an iso-osmolar contrast medium (IOCM).
  
  
  METHODS
  This single-center, prospective, randomized, double-blinded study included 92 patients in its final analysis (mean age 49.6 ± 12.6 years, 29.3% men, mean eGFR 97.8 ± 26.3 mL/min/1.73 m(2)). LOCM was used in 48 patients (52.2%) and IOCM in 44 patients (47.8%). The patients were given an average of 151.2 ± 52.1 mL of contrast medium intra-arterially. Serum creatinine (SCr), urinary N-acetyl-β-glucosaminidase (NAG) excretion, and creatinine clearance (CCr) were measured at baseline, and on days 1 and 3 after the procedure.
  
  
  RESULTS
  Baseline risk factors, renal functional parameters, and average CM doses were not statistically different between the two groups. SCr, NAG, and CCr values did not differ significantly between the LOCM and IOCM groups on days 1 and 3 after CM administration. Nephropathy developed in 21 cases (22.8%): 13 (27.1%) after LOCM use and 8 (18.2%) after IOCM; (P = NS). The only significant risk factors of CIN were the diabetes (P = 0.0466) and atherosclerosis (P = 0.0498).
  
  
  CONCLUSIONS
  We found a high incidence of nephropathy in neurosurgical patients after intra-arterial CM administration. The renal function values and incidence of nephropathy following LOCM administration were not statistically different from those following IOCM administration.
authors.affiliation: Department of Radiology and Diagnostic Imaging, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland. serafin@cm.umk.pl
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Serafin
authors.forename: Maciej
authors.initials: M
authors.lastname: Karolkiewicz
authors.forename: Marzena
authors.initials: M
authors.lastname: Gruszka
authors.forename: Pawel
authors.initials: P
authors.lastname: Strózecki
authors.forename: Wladyslaw
authors.initials: W
authors.lastname: Lasek
authors.forename: Grazyna
authors.initials: G
authors.lastname: Odrowaz-Sypniewska
authors.forename: Jacek
authors.initials: J
authors.lastname: Manitius
authors.forename: Wojciech
authors.initials: W
authors.lastname: Beuth
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects*; D048909:Diabetes Complications / Q000139:chemically induced; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D007472:Iohexol / Q000009:adverse effects / Q000031:analogs & derivatives; D007674:Kidney Diseases / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D009994:Osmolar Concentration; D011446:Prospective Studies; D012307:Risk Factors; D014283:Triiodobenzoic Acids / Q000009:adverse effects
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; C038192:iopromide; C044834:iodixanol