Comparison of nephrotoxicity between two gadolinium-contrasts, gadodiamide and gadopentetate in patients with mildly diminished renal failure

Abstract

-Although gadolinium (Gd)-based contrast media have been found to be nephrotoxic, their nephrotoxicity, and the dependence of nephrotoxicity on chelate types, have not been assessed in patients with normal or mildly diminished renal failure. This prospective, randomized study compared the nephrotoxicity of low doses of the nonionic Gd-based contrast medium gadodiamide (Omniscan®) and the ionic Gd-based contrast medium gadopentetate (Magnevist®) in patients with serum creatinine < 1.6 mg/dL. Patients aged 20 to 80 years, weighing 45 to 70 kg and with normal or < 1.6 mg/dL Serumcreatinine in the 3 months prior to undergoing magnetic resonance imaging (MRI) of brain, were enrolled. Patients were randomized to receive 0.1 mol/kg gadodiamide or gadopentetate. Serum-creatinine, serum cystatin-C, estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) formula, and estimated creatinine clearance rate (eCCr) using the Cockcroft-Gault formula were measured just before and 16-80 hr after MRI. Groups were compared statistically by Mann-Whitney U-tests and Wilcoxon signed-rank tests. There were no significant differences in clinical characteristics between the gadodiamide (n = 43) and gadopentetate (n = 59) groups. Serum-creatinine, eGFR and eCCr before and 16-80 hr after MRI did not differ significantly within either group or between the two groups. Serum cystatin-C was significantly higher 16-80 hr after than before MRI only in the gadodiamide group (0.79 ± 0.21 vs. 0.74 ± 0.14 mg/L, p = 0.028). The ionic contrast medium, gadopentetate, did not affect renal function during MRI, whereas the nonionic contrast medium, gadodiamide, affected renal function transiently.

Effects of Gadodiamide and Gadoteric Acid on Rat Kidneys: A Comparative Study

“…There are limited studies evaluating the nephrotoxicity of GBCAs. In the novel study by Naito et al, patients with normal or mildly diminished renal functions were analyzed according to nephrotoxicity through glomerular filtration rate (GFR), creatinine clearance, serum creatinine, and cystatin‐C levels, a biomarker that could display acute kidney injury earlier than creatinine. None of the patients experienced contrast‐induced nephrotoxicity.…”

“…None of the patients experienced contrast‐induced nephrotoxicity. The patients who were administered an ionic contrast medium, gadopentetate, were not affected; however, in the nonionic contrasted, gadodiamide group, a slight but significant increase in cystatin‐C levels was found . Our results demonstrated urea increase in the contrasted kidneys but we found similar serum creatinine levels between the groups.…”

Use of Intravenous Gadolinium-based Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation

“…Although the risk of NSF following intravenous administration of Food and Drug Administration-approved doses of group radiology.rsna.org n Radiology: Volume 00: Number 0-2020 ing a potential risk of nephrotoxicity in humans are uncontrolled retrospective studies and case reports (42)(43)(44). Since on-label dosing of intravenous GBCM is not associated with a clinically relevant risk of AKI, no prophylaxis is indicated for patients who will receive an on-label dose of group II or group III GBCM.…”

Use of Intravenous Gadolinium-Based Contrast Media in Patients With Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation

“…40,41 Existing literature implying a potential risk of nephrotoxicity in humans are uncontrolled retrospective studies and case reports. [42][43][44] Since on-label dosing of intravenous GBCM is not associated with a clinically relevant risk of AKI, no prophylaxis is indicated for patients who will receive an on-label dose of group II or group III GBCM.…”