Radiocontrast nephropathy: is it dose related or not?

ABSTRACT

To assess the safety of high dose non-ionic contrast media during a single radiological procedure in patients with pre-existing renal impairment. One hundred eighteen patients, with serum Creatinine greater than 1.3 mg/dl who were undergoing coronary angiography or percutaneous transluminal coronary angiography [PTCA] were included in the study. All patients received the nonionic dye ULTRAVIST [Iopromide]. Serum creatinine were measured before, 48 hours and 1 week after the administration of contrast agent. An acute contrast induced reduction in renal function was defined as an increase in Serum Creatinine concentration of >=0.5mg/dl, 48 hours after the administration of contrast agent. All patients with end stage renal disease or patients undergoing coronary bypass surgery within a week after coronary angiography or had any concomitant factors that could cause acute renal failure e.g., sepsis, hypotention, etc., were excluded. Patients receiving a dose of upto100 ml of contrast agent [low dose group] were separated from those who received greater than 100 ml of contrast agent [high dose group]. Patients in both groups had similar characteristics in terms of sex, age, weight and underlying disease. Student's t-test was used for statistical analysis. The mean age of our patients was 62.3 + 8.83 [range 40 - 84 years]. There were 93 [78.8%] males and 25 [21.2%] females. The mean pre-contrast creatinine in the low contrast group was 1.97+0.92 and high dose group was 2.16+1.90 [p=0.48]. The post-contrast Creatinine at 48 hours was 2.11+1.11 and 2.06+1.39 in the groups receiving low and high dose contrast agents respectively [p=0.830], while at 7 days post-contrast it was 2.17+1.28 and 1.95+1.43 respectively in the two groups [p=0.391]. The contrast-induced reduction in renal function [rise in serum Cr >=0.5 mg/dl above base line] occurred in 14% [n=8] of patients in low dose and in 11% [n=7] in high dose contrast group [p=0.830, insignificant]. The results of our study confirm that high dose non-ionic contrast is not associated with increased risk of contrast-mediated nephrotoxicity in patients with pre-existing renal insufficiency undergoing cardiac angiography [p=0.830, insignificant]