High incidence of nephropathy in neurosurgical patients after intra-arterial administration of low-osmolar and iso-osmolar contrast media

• Published in: Acta radiologica (1987) 2011-05, Vol.52 (4), p.422-429
• Main Authors: Serafin, Zbigniew, Karolkiewicz, Maciej, Gruszka, Marzena, Stróżecki, Paweł, Lasek, Władysław, Odrowąż-Sypniewska, Grażyna, Manitius, Jacek, Beuth, Wojciech
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - chemically induced; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiovascular system; Contrast Media - administration & dosage; Contrast Media - adverse effects; Contrast media. Radiopharmaceuticals; Diabetes Complications - chemically induced; Double-Blind Method; Female; Humans; Injections, Intra-Arterial; Investigative techniques, diagnostic techniques (general aspects); Iohexol - adverse effects; Iohexol - analogs & derivatives; Kidney Diseases - chemically induced; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Neurosurgical Procedures; Osmolar Concentration; Pharmacology. Drug treatments; Prospective Studies; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Renal failure; Risk Factors; Triiodobenzoic Acids - adverse effects
• ISSN: 0284-1851; 1600-0455
• DOI: 10.1258/ar.2011.100501

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. Purpose 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). Material and 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 m2). 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). Conclusion 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.