Gadolinium-based contrast agents and nephrotoxicity in patients undergoing coronary artery procedures

Objective: We tested whether gadolinium-based contrast agent is less nephrotoxic than iodinated-contrast media. Background: lodinated contrast agents are nephrotoxic. Some data suggest that gadolinium-based contrast agent may be less nephrotoxic than iodinated-contrast media. Methods: Twenty-five consecutive patients with chronic renal insufficiency (creatinine concentration >= 2.0 mg/dl and/or clearance <= 40 ml/min), referred to our institution for coronary procedures, were assigned to receive gadolinium-based contrast agents, a solution of gadolinium chelates diluted 3:1 by iso-osmolality contrast media (Gadolinium-based group). A control group of 32 patients with comparable clinical characteristics and treated with iodinated iso-osmolality contrast agent alone (Iodinated-based group) was selected from our database and compared with the Gadolinium-based group. In all cases, prophylactic administration of 0.45% saline intravenously and NAC (1200 mg orally twice daily) was used. Results: Baseline creatinine levels and creatinine clearance were similar in the 2 groups (Gadolinium-based group = 2.30 [IOR: 2.01-2.68] mg/dl and 33 +/- 13 ml/min; lodinated-based group = 2.24 [IOR: 2.05-2.65] mg/dl and 30 +/- 10 ml/min; P > 0.05 for all). Increase of at least 0.5 mg/dl of the creatinine concentration 48 hr after the procedure occurred in 7/25 (28%) patients in the Gadolinium-based group and in 2/32 (6.5%) patients in the lodinated-based group (P = 0.034; OR = 4.48; 95% CI = 1.01-19.17). Renal failure requiring temporary dialysis occurred in 2 (8%) patients in the Gadolinium-based group and in none in the lodinated-based group (P = 0.19). Conclusions: The strategy of gadolinium-based contrast agent administration does not seem to reduce the rate of CAN, as compared to the iodinated iso-osmolality contrast agent inpatients with chronic renal insufficiency. (c) 2006 Wiley-Liss, Inc.