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Nephrotoxicity of Contrast Media in High-Risk Patients with Renal Insufficiency: Comparison of Low- and High-Osmolar Contrast Agents

1991; Karger Publishers; Volume: 11; Issue: 4 Linguagem: Inglês

10.1159/000168328

1421-9670

Gilbert Deray, Marie‐France Bellin, Hacène Boulechfar, Bertrand Baumelou, Fabien Koskas, A Baumelou, Jean Grellet, Claude Jacobs,

Traumatic Brain Injury and Neurovascular Disturbances

We have compared the renal effects of ioxitalamate, ioxaglate, and iopamidol in patients with chronic renal failure. Sixty consecutive patients with an estimated creatinine clearance (ECRCl) < 60 ml/min were randomly assigned to receive either ioxitalamate, iopamidol, or ioxaglate. All patients received 500 cm3 isotonic saline before the procedure. Serum creatinine and ECRCl were estimated before, 1 and 2 or 3 days after the procedure. There was no statistical difference between the three groups with respect to age, sex, weight, renal function, amount of iodine, and type of procedure. Mean serum creatinine and ECRCl remained unchanged after administration of contrast media. No patient had nephrotoxicity or acute oliguria requiring dialysis as a result of the administration of contrast material. The number of patients with an increase in the serum creatinine level > 10% from the basal value did not differ in the treatment groups. The maximal increases in serum creatinine were 52 µmol/l (29%) in the ioxitalamate group, 56 µmol/l (18%) in the ioxaglate group, and 57 µmol/l (23%) in the iopamidol group (p = NS). Using a population carefully randomized and matched for renal insufficiency, we could not show any differences in nephrotoxicity between these three contrast agents. Clinically serious renal impairment was uncommon in our study, regardless of the contrast agent used. However, the interpretation of these favorable findings requires a cautionary note. All patients in this study were well hydrated before and after uro-/angiography, and none had a recent renal injury or a treatment with a nephrotoxic agent that would predispose to injury from contrast material. Furthermore, these results cannot be validated without further studying patients with terminal renal failure or patients with low cardiac output and congestive heart failure who cannot bear the risk of being even slightly overhydrated.