Abstract 3065: Gadolinium Does Not Prevent Contrast-Induced Nephropathy
Background: Contrast-induced nephropathy (CIN) is a common cause of hospital-acquired renal failure. Gadolinium-based contrast agents, such as gadodiamide, have been proposed as alternatives to iodinated contrast in patients at risk for CIN. The use of high-dose intraarterial gadodiamide-iodine contrast mixtures in the cath lab, however, has only been investigated in a small number of patients.
Methods: We compared patients with a creatinine clearance (CrCl) < 60 mg/dL who received either a gadodiamide-iodine mixture (N=90) or standard iodinated contrast (N=79 ) for diagnostic and/or interventional procedures in the cardiac cath lab. All patients received IV hydration (>/= 1500 cc) and oral N-acetylcysteine prophylaxis. CIN was defined as a 25% rise in serum creatinine (Cr) or an increase of 0.5 mg/dL from baseline (final Cr was measured 38 +/− 22 hrs post cath).
Results: Baseline clinical and demographic characteristics were similar between the study groups. Although the volume of contrast received by patients in the two groups was similar, less iodinated contrast was used in the gadodiamide-mixture group. No difference was found in the incidence of CIN between the two groups. Moreover, the initiation of dialysis and death occurred more frequently in the gadodiamide-iodine contrast mixture group. A step-down multivariate analysis found diabetes to be a predictor of CIN (p=0.25, OR=3.17, 95% CI=1.15– 8.72).
Conclusion: The incidence of CIN is not reduced in high-risk patients receiving a gadodiamide-iodinated contrast mixture versus iodinated contrast alone. The use of gadodiamide-iodine contrast mixtures does not appear to be beneficial in the prevention of CIN.