Gadolinium as an alternative contrast agent for diagnostic and interventional angiographic procedures in patients with impaired renal function

被引:69
作者
Rieger, J
Sitter, T
Toepfer, M
Linsenmaier, U
Pfeifer, KJ
Schiffl, H
机构
[1] Univ Munich, Med Klin Innenstadt, Dept Radiol, Munich, Germany
[2] Univ Munich, Med Klin Innenstadt, Dept Nephrol, Munich, Germany
关键词
angiography; contrast induced nephropathy; gadolinium; gadopentetate dimeglumine; renal artery stenosis;
D O I
10.1093/ndt/17.5.824
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Background. The study was designed to investigate the safety and feasibility of gadopentetate dimeglumine, a gadolinium-based contrast Medium, as an alternative angiographic contrast agent in patients with impaired renal function and high risk for iodinated contrast-induced nephropathy. Methods. Gadopentetate dimeglumine was used as the radiographic contrast agent in 32 diagnostic or interventional angiographic procedures in 29 patients (59% diabetics) with severe renal insufficiency (average serum creatinine of 3.6 +/- 1.4 mg/dl). The average dose of gadopentetate dimeglumine was 0.34 +/- 0.06 mmol/kg body weight. Gadopentetate dimeglumine was used either alone (n = 20) or in conjunction with carbon dioxide (n = 12). Results. Thirty-two angiographic procedures (24 diagnostic angiographies and 8 interventional procedures) were performed in 29 patients. For diagnostic purposes. eleven selective renal arteriographies. six angiographies of the iliac arteries and lower extremities, and seven venous angiographies of the Upper extremity and central veins were performed. Interventional procedures consisted of two percutaneous transluminal renal angioplasties with stenting, four percutaneous peripheral vascular interventions, and two balloon angioplasties of a dialysis fistula. None of the patients, except one, had evidence of post-procedure contrast material-induced renal failure (increase in serum creatinine > 0.5 mg/dl within 72 h) or other complications. This patient had a clinically important increase in serum creatinine level after percutaneous transluminal renal angioplasty and stenting, probably due to cholesterol embolism. Gadopentetate dimeglumine had sufficient radiographic density to allow adequate diagnostic visualization with digital subtraction equipment in all cases. Conclusions. Gadopentetate dimeglumine is in alternative and safe radiographic contrast agent For angiography and interventional procedures in patients with severe pre-existing renal impairment. In this population with high risk for contrast-induced acute renal failure, it is obviously less nephrotoxic than iodinated contrast media.
引用
收藏
页码:824 / 828
页数:5
相关论文
共 24 条
[1]   Systemic gadolinium toxicity in patients with renal insufficiency and renal failure: Retrospective analysis of an initial experience [J].
Arsenault, TM ;
King, BF ;
Marsh, JW ;
Goodman, JA ;
Weaver, AL ;
Wood, CP ;
Ehman, RL .
MAYO CLINIC PROCEEDINGS, 1996, 71 (12) :1150-1154
[2]   RENAL TOLERANCE OF GADOLINIUM-DOTA AND GADOLINIUM-DTPA IN RATS [J].
BRILLET, G ;
DUBOIS, M ;
BEAUFILS, H ;
BOURBOUZE, R ;
DERAY, G .
INVESTIGATIVE RADIOLOGY, 1994, 29 (03) :352-354
[3]   THE FUNCTIONAL-EFFECTS OF GADOLINIUM-DTPA ON THE ISOLATED PERFUSED RAT-KIDNEY [J].
BROWN, PWG ;
HAYLOR, JL ;
MORCOS, SK ;
ELNAHAS, AM .
EUROPEAN JOURNAL OF RADIOLOGY, 1993, 16 (02) :85-89
[4]  
Fobbe F, 1996, EUR RADIOL, V6, P224
[5]   Acute renal failure after arteriography with a gadolinium-based contrast agent [J].
Gemery, J ;
Idelson, B ;
Reid, S ;
Yucel, EK ;
Pagan-Marin, H ;
Ali, S ;
Casserly, L .
AMERICAN JOURNAL OF ROENTGENOLOGY, 1998, 171 (05) :1277-1278
[6]   Gadolinium dimeglumine: an alternative contrast agent for digital subtraction angiography [J].
Hammer, FD ;
Goffette, PP ;
Malaise, J ;
Mathurin, P .
EUROPEAN RADIOLOGY, 1999, 9 (01) :128-136
[7]   RENAL TOLERANCE OF GADOLINIUM-DTPA DIMEGLUMINE IN PATIENTS WITH CHRONIC-RENAL-FAILURE [J].
HAUSTEIN, J ;
NIENDORF, HP ;
KRESTIN, G ;
LOUTON, T ;
SCHUHMANNGIAMPIERI, G ;
CLAUSS, W ;
JUNGE, W .
INVESTIGATIVE RADIOLOGY, 1992, 27 (02) :153-156
[8]   HOSPITAL-ACQUIRED RENAL-INSUFFICIENCY - A PROSPECTIVE-STUDY [J].
HOU, SH ;
BUSHINSKY, DA ;
WISH, JB ;
COHEN, JJ ;
HARRINGTON, JT .
AMERICAN JOURNAL OF MEDICINE, 1983, 74 (02) :243-248
[9]   RENAL HANDLING AND PHYSIOLOGICAL-EFFECTS OF THE PARAMAGNETIC CONTRAST-MEDIUM GD-DOTA [J].
KATZBERG, RW ;
SAHLER, LG ;
DUDA, SW ;
MORRIS, TW ;
MCKENNA, BA ;
PABICO, RC ;
NIEDRACH, WL ;
TONETTI, FW .
INVESTIGATIVE RADIOLOGY, 1990, 25 (06) :714-719
[10]   Renal insufficiency: Gadopentetate dimeglumine as a radiographic contrast agent during peripheral vascular interventional procedures [J].
Kaufman, JA ;
Geller, SC ;
Waltman, AC .
RADIOLOGY, 1996, 198 (02) :579-581