Iso-Osmolality versus Low-Osmolality Iodinated Contrast Medium at Intravenous Contrast-enhanced CT: Effect on Kidney Function

Abstract

Intravenous contrast material application in high-risk patients is unlikely to be associated with permanent adverse outcomes. SCr levels after contrast material administration are lower in iodixanol than iopromide groups.

Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

“…In one of the studies, an incidence as high as 42% was observed in a subgroup of patients with marked reduction of renal function (sCr >221 μmol/L) after receiving 22 g-I from the low osmolality CM (LOCM) iopromide [19]. In two CT studies [19,20] the CIN risk figures are well in line with the 26% and 33% CIN rates of iohexol in patients with renal insufficiency and diabetes mellitus following cardioangiography with a mean dose of about 50 g-I iodine in the Nephric Study [12] and Iohexol Cooperative study [11], respectively. Thus, the risk of CIN may be within the same range at similar CM doses.…”

“…are often excluded [20,30,[33][34][35][36]. This bias in patient selection compared with IA coronary procedures, where high-risk patients cannot be excluded from life-saving interventions, may in part contribute to the belief that IV CM injection implies a lower risk of CIN than IA administration.…”

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

“…In a review of 7 prospective observational studies, the overall incidence of CIN was 5.4 % in patients with CKD who intravenously received low-or iso-osmolar contrast media, which suggested that intravenous administration of contrast media may pose a smaller risk of CIN as compared with that seen with intraarterial administration [42]. Table 7 lists the incidence of CIN in patients with CKD after receiving different contrast media [5,[65][66][67][68][69][70]. Table 8 Recently, CAG and catheter-based revascularization have become common procedures, and the use of contrast media has increased substantially.…”

Contrast Medium-Induced Nephropathy (CIN) Gram-Iodine/GFR Ratio to Predict CIN and Strategies to Reduce Contrast Medium Doses

“…In the relatively few published reports of CIN following CM-enhanced CT the incidence may vary between 0 and 42% depending on definitions, degree of renal impairment and number and degree of risk factors (Katzberg & Newhouse, 2010;Nguyen et al, 2008;Polena et al, 2005;Tepel et al, 2000;Thomsen et al, 2008b). In a recent prospective study of unselected emergency patients 11% (n=70/633) increased their serum creatinine ≥44 µmol/L or ≥25% of whom 9% (n=6) developed CM-induced severe renal failure, which contributed to death in 4 of the 6 patients (Mitchell et al, 2010).…”

“…unstable renal function, heart failure, uncontrolled diabetes, recent CM examinations, etc.) are often excluded (Barrett et al, 2006;Kuhn et al, 2008;Nguyen et al, 2008;Thomsen et al, 2008b). This bias in patient selection compared with coronary studies, where high-risk patients can not be excluded from life-saving procedures, may in part explain the illusive opinion that an IV CM injection implies a lesser risk of CIN than an IA.…”