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

@article{citeulike:1335889, abstract = {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 m(2)] 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 m(2) within 48 h after CM administration (P<0.05, paired t test). The incidence of CM-induced ARF amounted to 50\%. In comparison, the iohexol group (n = 11) also showed a statistically significant GFR reduction of 8.7+/-8.8 ml/min/1.73 m(2) (P<0.05, paired t test), and of ARF by 45\%. The percentile of differences of GFR decreases between the two groups was not significant (P = 0.70). No patient demonstrated other adverse effects of gadobutrol or iohexol administration, apart from GFR reduction. Despite the decline in GFR, no patient required haemodialysis in the 10 following days. CONCLUSIONS: In our study, gadolinium-based angiography showed no benefit over iohexol angiography with respect to preventing GFR reduction in patients with severely impaired renal function.}, address = {University of T\"{u}bingen, Department of Internal Medicine, Section for Nephrology and Hypertension, Germany. christiane.erley@sjk.de}, author = {Erley, C. M. and Bader, B. D. and Berger, E. D. and Tuncel, N. and Winkler, S. and Tepe, G. and Risler, T. and Duda, S.}, citeulike-article-id = {1335889}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/15280530}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=15280530}, issn = {0931-0509}, journal = {Nephrol Dial Transplant}, keywords = {contrastnephropathy}, month = {October}, number = {10}, pages = {2526--2531}, posted-at = {2007-05-26 22:49:56}, priority = {2}, title = {Gadolinium-based contrast media compared with iodinated media for digital subtraction angiography in azotaemic patients.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/15280530}, volume = {19}, year = {2004} }

TY - JOUR ID - citeulike:1335889 L3 - citeulike-article-id:1335889 N2 - 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 m(2)] 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 m(2) within 48 h after CM administration (P<0.05, paired t test). The incidence of CM-induced ARF amounted to 50%. In comparison, the iohexol group (n = 11) also showed a statistically significant GFR reduction of 8.7+/-8.8 ml/min/1.73 m(2) (P<0.05, paired t test), and of ARF by 45%. The percentile of differences of GFR decreases between the two groups was not significant (P = 0.70). No patient demonstrated other adverse effects of gadobutrol or iohexol administration, apart from GFR reduction. Despite the decline in GFR, no patient required haemodialysis in the 10 following days. CONCLUSIONS: In our study, gadolinium-based angiography showed no benefit over iohexol angiography with respect to preventing GFR reduction in patients with severely impaired renal function. IS - 10 JF - Nephrol Dial Transplant SN - 0931-0509 AD - University of Tübingen, Department of Internal Medicine, Section for Nephrology and Hypertension, Germany. christiane.erley@sjk.de EP - 2531 TI - Gadolinium-based contrast media compared with iodinated media for digital subtraction angiography in azotaemic patients. VL - 19 SP - 2526 KW - contrastnephropathy AU - Erley, CM AU - Bader, BD AU - Berger, ED AU - Tuncel, N AU - Winkler, S AU - Tepe, G AU - Risler, T AU - Duda, S PY - 2004/10// UR - http://view.ncbi.nlm.nih.gov/pubmed/15280530 ER -