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Safety of gadodiamide mixed with a small quantity of iohexol in patients with impaired renal function undergoing coronary angiography

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Abstract

Gadolinium-based contrast agents can be used in diagnostic and interventional angiography, and are safe in recommended doses in patients with impaired renal function, but the image quality is usually unsatisfactory. The objective of the present study is to evaluate the safety of gadolinium mixed with a small quantity of iodine-based contrast agent and the image quality of this mixture in patients with renal insufficiency undergoing diagnostic coronary angiography. Forty-two patients with baseline creatinine level >1.5 mg/dl were randomized into gadolinium or iodine groups. In the gadolinium group gadodiamide was mixed with 1 : 3 iohexole and in the iodine group only this agent was used as contrast material. Peak creatinine levels 48–72 h after the procedure were measured. The primary end point was the development of contrast-induced nephropathy (CIN), defined as >25% increase of baseline creatinine levels, and the secondary end points were absolute and relative changes in baseline creatinine levels. Total contrast volumes used were not different between groups (57 ± 11 ml in gadolinium and 55 ± 10 ml in iodine; P = 0.68). Mean creatinine level did not increase significantly in the gadolinium group (from 1.9 ± 0.3 to 1.9 ± 0.4 mg/dl; P = 0.06), but did in the iodine group (from 2.0 ± 0.4 to 2.3 ± 0.5 mg/dl; P = 0.001). No patient had CIN in the gadolinium group whereas 5 (23%) patients had this phenomenon in the iodine group (P = 0.048). Contrast regimen was very well tolerated in the gadolinium group, with only transient headache in two patients. Gadodiamide mixed with a small quantity of iohexol is safe in patients with azotemia undergoing diagnostic coronary angiography. The image qualities obtained with this combination are also satisfactory in all of the cases. Further evaluation of the safety of this technique is warranted, especially in other types of diagnostic and interventional procedures in which a higher amount of contrast dye is needed.

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References

  1. L Gruberg GS Mintz R Mehran G Gangas AJ Lansky KM Kent AD Pichard LF Satler MB Leon (2000) ArticleTitleThe prognostic implications of further renal deterioration within 48 h of interventional coronary procedures in patients with pre-existing chronic renal insufficiency J Am Coll Cardiol 36 1542–1548 Occurrence Handle11079656 Occurrence Handle1:STN:280:DC%2BD3M%2FnsVGmtQ%3D%3D Occurrence Handle10.1016/S0735-1097(00)00917-7

    Article  PubMed  CAS  Google Scholar 

  2. PA McCullough R Wolyn LL Rocher RN Levin WW O’Neill (1997) ArticleTitleAcute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality Am J Med 103 368–375 Occurrence Handle9375704 Occurrence Handle1:STN:280:DyaK1c%2FktFGmsA%3D%3D Occurrence Handle10.1016/S0002-9343(97)00150-2

    Article  PubMed  CAS  Google Scholar 

  3. MW Rich CA Crecelius (1990) ArticleTitleIncidence, risk factors, and clinical course of acute renal insufficiency after cardiac catheterization in patients 70 years of age or older: a prospective study Arch Intern Med 150 1237–1242 Occurrence Handle2353856 Occurrence Handle1:STN:280:DyaK3c3ot1GktA%3D%3D Occurrence Handle10.1001/archinte.150.6.1237

    Article  PubMed  CAS  Google Scholar 

  4. RC Cigarroa RA Lange RH Williams LD Hillis (1989) ArticleTitleDosing of contrast material to prevent contrast nephropathy in patients with renal disease Am J Med 86 649–652 Occurrence Handle2729314 Occurrence Handle1:STN:280:DyaL1M3ntVGguw%3D%3D Occurrence Handle10.1016/0002-9343(89)90437-3

    Article  PubMed  CAS  Google Scholar 

  5. F Boccalandro M Ahmad RW Smalling S Sdringola (2003) ArticleTitleOral acetylcysteine does not protect renal function from moderate to high doses of intravenous radiographic contrast Catheter Cardiovasc Interv 58 336–341 Occurrence Handle12594698 Occurrence Handle10.1002/ccd.10389

    Article  PubMed  Google Scholar 

  6. GW Stone PA McCullough JA Tumlin NE Lepor H Madyoon P Murray A Wang AA Chu GL Schaer M Stevens RL Wilensky WW O’Neill (2003) ArticleTitleFenoldopam mesylate for the prevention of contrast-induced nephropathy: a randomized controlled trial JAMA 290 2284–2291 Occurrence Handle14600187 Occurrence Handle1:CAS:528:DC%2BD3sXovVCjs7w%3D Occurrence Handle10.1001/jama.290.17.2284

    Article  PubMed  CAS  Google Scholar 

  7. F De Ridder M De Maeseneer T Stadnik R Luypaert M Osteaux (2001) ArticleTitleSevere adverse reactions with contrast agents for magnetic resonance: clinical experience in 30,000 MR examinations JBR-BTR 84 150–152 Occurrence Handle11688727 Occurrence Handle1:STN:280:DC%2BD3Mnjs1Whtg%3D%3D

    PubMed  CAS  Google Scholar 

  8. VM Runge (2001) ArticleTitleSafety of magnetic resonance contrast media Top Magn Reson Imaging 12 309–314 Occurrence Handle11687717 Occurrence Handle1:STN:280:DC%2BD3MnjvFGitA%3D%3D Occurrence Handle10.1097/00002142-200108000-00007

    Article  PubMed  CAS  Google Scholar 

  9. P Joffe HS Thomsen M Meusel (1998) ArticleTitlePharmacokinetics of gadodiamide injection in patients with severe renal insufficiency and patients undergoing hemodialysis or continuous ambulatory peritoneal dialysis Acad Radiol 5 491–502 Occurrence Handle9653466 Occurrence Handle1:STN:280:DyaK1czhslenug%3D%3D Occurrence Handle10.1016/S1076-6332(98)80191-8

    Article  PubMed  CAS  Google Scholar 

  10. D Spinosa A Matsumoto K Hagspiel JF Angel G Hartwell (1999) ArticleTitleGadolinium-based contrast agents in angiography and interventional radiology Am J Roentgenol 173 1403–1409 Occurrence Handle1:STN:280:DC%2BD3c%2FgslWnsA%3D%3D

    CAS  Google Scholar 

  11. GA Krinsky R Freedberg VS Lee C Rockman PA Tunick (2001) ArticleTitleInnominate artery atheroma: a lesion seen with gadolinium-enhanced MR angiography and often missed by transesophageal echocardiography Clin Imaging 25 251–257 Occurrence Handle11566085 Occurrence Handle1:STN:280:DC%2BD3MrhvFagtA%3D%3D Occurrence Handle10.1016/S0899-7071(01)00292-3

    Article  PubMed  CAS  Google Scholar 

  12. FD Hammer J Malaise PP Goffette P Mathurin (2000) ArticleTitleGadolinium dimeglumine: an alternative contrast agent for digital subtraction angiography in patients with renal failure Transplant Proc 32 432–433 Occurrence Handle10715468 Occurrence Handle1:CAS:528:DC%2BD3cXhslaku70%3D Occurrence Handle10.1016/S0041-1345(00)00840-X

    Article  PubMed  CAS  Google Scholar 

  13. A Sarkis G Badaoui R Azar G Sleilaty R Basil VA Jebara (2003) ArticleTitleGadolinium-enhanced coronary angiography in patients with impaired renal function Am J Cardiol 91 974–975 Occurrence Handle12686340 Occurrence Handle10.1016/S0002-9149(03)00116-4

    Article  PubMed  Google Scholar 

  14. National Kidney Foundation (2002) ArticleTitleK/DOCI clinical practice guidelines for chronic kidney disease for evaluation, classification and stratification Am J Kidney Dis 39 S76–92 Occurrence Handle10.1053/ajkd.2002.30944

    Article  Google Scholar 

  15. AG Hatrick JM Jarosz AT Irvine (1997) ArticleTitleGadopentetate dimeglumine as an alternative contrast agent for use in interventional procedures Clin Radiol 52 948–952 Occurrence Handle9413971 Occurrence Handle1:STN:280:DyaK1c%2FnsVOrsA%3D%3D Occurrence Handle10.1016/S0009-9260(97)80230-9

    Article  PubMed  CAS  Google Scholar 

  16. ES Nussbaum SO Casey LA Sebring MT Madison (2000) ArticleTitleUse of gadolinium as an intraarterial contrast agent in digital subtraction angiography of the cervical carotid arteries and intracranial circulation. Technical note J Neurosurg 92 881–883 Occurrence Handle10794307 Occurrence Handle1:STN:280:DC%2BD3c3lt1arsw%3D%3D Occurrence Handle10.3171/jns.2000.92.5.0881

    Article  PubMed  CAS  Google Scholar 

  17. SG Slaba LF El-Hajj GA Abboud VA Gebara (2000) ArticleTitleSelective angiography of cerebral aneurysm using gadodiamide in polycystic kidney disease with renal insufficiency Am J Roentgenol 175 1467–1468 Occurrence Handle1:STN:280:DC%2BD3M%2FisVynsg%3D%3D

    CAS  Google Scholar 

  18. JM Murphy NJ O’Hare P Smiddy MP Molloy (1998) ArticleTitleGadopentetate dimeglumine as a contrast agent in peripheral angioplasty. A case report Acta Radiol 39 576–578 Occurrence Handle9755712 Occurrence Handle1:STN:280:DyaK1cvivVCmsg%3D%3D Occurrence Handle10.3109/02841859809172229

    Article  PubMed  CAS  Google Scholar 

  19. A Sarkis G Badaoui S Slaba A Moussalli VA Jebara (2001) ArticleTitleGadolinium-based coronarography in a patient with renal failure: first clinical report Catheter Cardiovasc Interv 54 68–69 Occurrence Handle11553951 Occurrence Handle1:STN:280:DC%2BD3MrgtlKgsg%3D%3D Occurrence Handle10.1002/ccd.1240

    Article  PubMed  CAS  Google Scholar 

  20. SW Bokhari YH Wen RJ Winters (2003) ArticleTitleGadolinium-based percutaneous coronary intervention in a patient with renal insufficiency Catheter Cardiovasc Interv 58 358–361 Occurrence Handle12594702 Occurrence Handle10.1002/ccd.10414

    Article  PubMed  Google Scholar 

  21. E Storm H Israel (1970) Photon cross sections from 1 keV to 100 MeV for elements Z-1 to Z-100 Nuclear data tables. vol 7, section A Academic Press New York 565

    Google Scholar 

  22. CM Badiola (2004) ArticleTitleUse of a mixture of gadolinium and iodinated contrast for angiography Cardiovasc Intervent Radiol 27 148–150 Occurrence Handle15259810 Occurrence Handle10.1007/s00270-003-2643-8

    Article  PubMed  Google Scholar 

  23. AD Sam Suffix2nd MD Morasch J Collins G Song R Chen FS Pereless (2003) ArticleTitleSafety of Gadolinium contrast angiography in patients with chronic renal insufficiency J Vasc Surg 38 313–308 Occurrence Handle12891113 Occurrence Handle10.1016/S0741-5214(03)00315-X

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Gulhane Military Medical Academy, Ankara Jandarma Hastanesi, Kardiyoloji Servisi, Beytepe, Ankara, Turkey

    Cem Barcin, Hurkan Kursaklioglu, Atilla Iyisoy, Sedat Kose, Hasan Fehmi Tore & Ersoy Isik

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  1. Cem Barcin
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  2. Hurkan Kursaklioglu
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  3. Atilla Iyisoy
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  4. Sedat Kose
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  5. Hasan Fehmi Tore
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  6. Ersoy Isik
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Correspondence to Cem Barcin.

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Barcin, C., Kursaklioglu, H., Iyisoy, A. et al. Safety of gadodiamide mixed with a small quantity of iohexol in patients with impaired renal function undergoing coronary angiography. Heart Vessels 21, 141–145 (2006). https://doi.org/10.1007/s00380-005-0879-8

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  • DOI: https://doi.org/10.1007/s00380-005-0879-8

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