[Effectiveness of nephroprotection by the selection of contrast media used during vascular interventions in patients with chronic renal failure?].
BACKGROUND
The increasing number of endovascular procedures made aware of a kidney disease induced by contrast media (CM). Contrast-induced nephropathy (= CIN) can develop in 0.6-44 % of the treated patients by angiography and / or endovascular intervention. The incidence in high-risk patients ranges from 50 to 70 %. In most cases CIN is inconspicuous and reversible. But pre-existing chronic kidney disease, diabetes mellitus, age and variable different risk factors (e. g., PAOD) can induce irreversible renal impairment. The purpose of the presented trial is to investigate incidence, predictors, and out-come of CIN in chronic renal failure patients using two different CM; one non-ionic isoosmolar -iodixanol and the other non-ionic low-osmolar iopromide.


METHODS
To evaluate the incidence of CIN after endovascular diagnostics and intervention two collectives of 100  patients with chronic renal insufficiency were treated with different contrast media (CM). Inclusion followed prospectively in two collectives. One collective received iopromide (Ultravist™, Bayer Health Care, Lever-kusen, Germany), and the second hundred patients received iodixanol (Visipaque™, Nycomed Amersham, Princeton, New Jersey). Demographics, comorbidities, procedure-related data were completed by serum creatinine levels and GFR (= glomerular filtration rate). Inclusion criteria were a serum creatinine level ≥ 1.5 mg% and a GFR ≤ 60 mL / min. Those parameters were measured twice pre-interventionally, and one time 48-72  hours after the endovascular procedure.


RESULTS
Collectives were homogenous and comparable concerning pre-existing risk factors, age and gender. Renal function stayed at a constant level and was independent of contrast medium selection, repectively. Average creatinine levels ranged around 1.77 mg% ± 0.75  standard deviation (SD) pre-interventionally; postinterventional measurement exposed a creatinine level of 1.74 mg% ± 0.74 SD as mean of both collectives. GFR (preinterventional 39.64 mL / min ± 12.48 SD) increased non-significantly to 45.48 mL / min ± 16.82 SD. Pre-existing chronic kidney disease had no effect on renal function parameters; no other risk factors could be evaluated.


CONCLUSIONS
According to cost-effectiveness a low-osmolar monomeric contrast medium (LOCM) is a sufficient selection, under careful renal function control.
Klinik für Gefäßchirurgie, St-Franziskushospital, Gefäßchirurgie, Münster, Deutschland. Eva.Schoenefeld@ukmuenster.de
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Schönefeld
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Höwler
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Osada
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Torsello
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000191:economics; D000800:Angioplasty, Balloon / Q000191:economics; D003287:Contrast Media / Q000008:administration & dosage / Q000191:economics / Q000633:toxicity*; D003362:Cost-Benefit Analysis; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives* / Q000191:economics / Q000633:toxicity; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging* / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging* / Q000628:therapy*; D012307:Risk Factors; D014283:Triiodobenzoic Acids / Q000191:economics / Q000633:toxicity*
D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; C038192:iopromide; D003404:Creatinine; C044834:iodixanol