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

• Published in: The American journal of cardiology Vol. 100; no. 7; pp. 1090 - 1093
• Main Authors: Reed, Pamela S., MD, Dixon, Simon R., MBChB, Boura, Judith A., MS, O’Neill, William W., MD, Kahn, Joel K., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2007; Elsevier; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cardiovascular system; Chronic Disease; Contrast Media - adverse effects; Coronary Angiography - adverse effects; Coronary Angiography - methods; Female; Gadolinium DTPA - adverse effects; Humans; Incidence; Investigative techniques, diagnostic techniques (general aspects); Iohexol - adverse effects; Ioxaglic Acid - adverse effects; Kidney diseases; Kidney Diseases - chemically induced; Kidney Diseases - complications; Kidney Diseases - epidemiology; Kidney Diseases - prevention & control; Kidneys; Male; Medical imaging; Medical sciences; Middle Aged; Multivariate analysis; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Renal failure; Retrospective Studies; Risk factors; Triiodobenzoic Acids - adverse effects; Urinary system involvement in other diseases. Miscellaneous; Kidney disease; Human; Urinary system disease; Radiodiagnosis; Toxicity; Patient; Chronic kidney disease; Coronary arteriography; Contrast; Phlebology; Mixture; Prevention; Gadodiamide; Renal failure; Radioopaque marker; Circulatory system; Cardiology; Comparative study; Contrast media; Iodine
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2007.04.055

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 (≥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.