Gadolinium-based contrast agents and nephrotoxicity in patients undergoing coronary artery procedures

Carlo Briguori, Antonio Colombo, Flavio Airoldi, Gloria Melzi, Iassen Michev, Mauro Carlino, Matteo Montorfano, Alaide Chieffo, Raimondo Bellanca, Bruno Ricciardelli

Research output: Contribution to journalArticle

Abstract

Objective: We tested whether gadolinium-based contrast agent is less nephrotoxic than iodinated-contrast media. Background: Iodinated contrast agents are nephrotoxic. Some data suggest that gadolinium-based contrast agent may be less nephrotoxic than iodinated-contrast media. Methods: Twenty-five consecutive patients with chronic renal insufficiency (creatinine concentration ≥2.0 mg/dl and/or clearance ≤40 ml/min), referred to our institution for coronary procedures, were assigned to receive gadolinium-based contrast agents, a solution of gadolinium chelates diluted 3:1 by iso-osmolality contrast media (Gadolinium-based group). A control group of 32 patients with comparable clinical characteristics and treated with iodinated iso-osmolality contrast agent alone (Iodinated-based group) was selected from our database and compared with the Gadolinium-based group. In all cases, prophylactic administration of 0.45% saline intravenously and NAC (1200 mg orally twice daily) was used. Results: Baseline creatinine levels and creatinine clearance were similar in the 2 groups (Gadolinium-based group = 2.30 [IQR: 2.01-2.68] mg/dl and 33 ± 13 ml/min; Iodinated-based group = 2.24 [IQR: 2.05-2.65] mg/dl and 30 ± 10 ml/min; P > 0.05 for all). Increase of at least 0.5 mg/dl of the creatinine concentration 48 hr after the procedure occurred in 7/25 (28%) patients in the Gadolinium-based group and in 2/32 (6.5%) patients in the Iodinated-based group (P = 0.034; OR = 4.48; 95% Cl = 1.01-19.17). Renal failure requiring temporary dialysis occurred in 2 (8%) patients in the Gadolinium-based group and in none in the Iodinated-based group (P = 0.19). Conclusions: The strategy of gadolinium-based contrast agent administration does not seem to reduce the rate of CAM, as compared to the iodinated iso-osmolality contrast agent in patients with chronic renal insufficiency.

Original languageEnglish
Pages (from-to)175-180
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume67
Issue number2
DOIs
Publication statusPublished - Feb 2006

Keywords

  • Complications
  • Contrast media
  • Kidney
  • Prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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