Gadolinium-based contrast media compared with iodinated media for digital subtraction angiography in azotaemic patients

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2004-10, Vol.19 (10), p.2526-2531
• Main Authors: Erley, Christiane M., Bader, Birgit D., Berger, Elke D., Tuncel, Nurdan, Winkler, Sabine, Tepe, Gunnar, Risler, Teut, Duda, Stephan
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; angiography; Angiography, Digital Subtraction; Aortic Aneurysm - diagnostic imaging; Biological and medical sciences; Contrast Media - adverse effects; contrast media plasma clearance; contrast media-induced nephropathy; Double-Blind Method; Emergency and intensive care: renal failure. Dialysis management; Female; gadolinium; Gadolinium - adverse effects; glomerular filtration rate; Glomerular Filtration Rate - drug effects; Glomerulonephritis; Humans; Intensive care medicine; iohexol; Iohexol - adverse effects; Male; Medical sciences; Middle Aged; Miscellaneous; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Organometallic Compounds - adverse effects; Pilot Projects; Public health. Hygiene; Public health. Hygiene-occupational medicine; Renal Artery Obstruction - diagnostic imaging; Renal Insufficiency - complications; Renal Insufficiency - physiopathology; Severity of Illness Index; Uremia - diagnostic imaging; Uremia - etiology; Vascular Diseases - diagnostic imaging
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfh272

Background. To determine whether gadolinium-based contrast media (CM) could be used safely for angiographies in patients with renal dysfunction we investigated renal function after gadobutrol exposure and compared the results with standard iodinated CM (iohexol) in a randomized clinical study. Methods. Twenty-one patients (aged 67±11 years, nine female and 12 male) with severely impaired renal function [mean serum creatinine 3.2±1.3 mg/dl, mean glomerular filtration rate (GFR) 31±16 ml/min/1.73 m2] who needed to have angiography because of severe peripheral vascular disease, renal artery stenosis or aortic aneurysms were randomized to receive in a blinded manner either gadobutrol (Gadovist® 1.0 mmol/ml) or iohexol (Omnipaque® 350) as contrast agents. GFR was measured by CM clearance (Renalyzer®) at baseline and 48 h after CM administration. The primary end point was the mean change of GFR from baseline at 48 h, the secondary one the incidence of CM-induced acute renal failure, defined as a decrease in GFR of >50% from baseline within 48 h of CM administration. Results. In the gadobutrol group (n = 10) we observed a statistically significant decrease in GFR of 10.6±13.8 ml/min/1.73 m2 within 48 h after CM administration (P