Abstract:
BACKGROUND:The increasing number of endovascular procedures made aware of a kidney disease induced by contrast media (CM). Contrast-induced nephropathy (= CIN) can develop in 0.6-44 % of the treated patients by angiography and / or endovascular intervention. The incidence in high-risk patients ranges from 50 to 70 %. In most cases CIN is inconspicuous and reversible. But pre-existing chronic kidney disease, diabetes mellitus, age and variable different risk factors (e. g., PAOD) can induce irreversible renal impairment. The purpose of the presented trial is to investigate incidence, predictors, and out-come of CIN in chronic renal failure patients using two different CM; one non-ionic isoosmolar -iodixanol and the other non-ionic low-osmolar iopromide. METHODS:To evaluate the incidence of CIN after endovascular diagnostics and intervention two collectives of 100 patients with chronic renal insufficiency were treated with different contrast media (CM). Inclusion followed prospectively in two collectives. One collective received iopromide (Ultravist™, Bayer Health Care, Lever-kusen, Germany), and the second hundred patients received iodixanol (Visipaque™, Nycomed Amersham, Princeton, New Jersey). Demographics, comorbidities, procedure-related data were completed by serum creatinine levels and GFR (= glomerular filtration rate). Inclusion criteria were a serum creatinine level ≥ 1.5 mg% and a GFR ≤ 60 mL / min. Those parameters were measured twice pre-interventionally, and one time 48-72 hours after the endovascular procedure. RESULTS:Collectives were homogenous and comparable concerning pre-existing risk factors, age and gender. Renal function stayed at a constant level and was independent of contrast medium selection, repectively. Average creatinine levels ranged around 1.77 mg% ± 0.75 standard deviation (SD) pre-interventionally; postinterventional measurement exposed a creatinine level of 1.74 mg% ± 0.74 SD as mean of both collectives. GFR (preinterventional 39.64 mL / min ± 12.48 SD) increased non-significantly to 45.48 mL / min ± 16.82 SD. Pre-existing chronic kidney disease had no effect on renal function parameters; no other risk factors could be evaluated. CONCLUSION:According to cost-effectiveness a low-osmolar monomeric contrast medium (LOCM) is a sufficient selection, under careful renal function control.
journal_name
Zentralbl Chirjournal_title
Zentralblatt fur Chirurgieauthors
Schönefeld E,Höwler S,Osada N,Torsello Gdoi
10.1055/s-0031-1283759subject
Has Abstractpub_date
2011-10-01 00:00:00pages
426-30issue
5eissn
0044-409Xissn
1438-9592journal_volume
136pub_type
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journal_title:Zentralblatt fur Chirurgie
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journal_title:Zentralblatt fur Chirurgie
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journal_title:Zentralblatt fur Chirurgie
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journal_title:Zentralblatt fur Chirurgie
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