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Renal effects of CO2 and iodinated contrast media in patients undergoing renovascular intervention: a prospective, randomized study
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för radiologi.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för radiologi.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
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2005 (Engelska)Ingår i: Journal of Vascular and Interventional Radiology, ISSN 1051-0443, E-ISSN 1535-7732, Vol. 16, nr 1, s. 57-65Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

PURPOSE: CO2 gas has been proposed for use instead of iodinated contrast media in angiographic examinations in patients at risk of developing renal failure from contrast media. The influence of intraarterial injection of CO2 with small added amounts of ioxaglate (200 mgI/mL) or ioxaglate alone on renal function in patients with suspected renal artery stenosis was studied in a prospective, randomized study. MATERIALS AND METHODS: One hundred twenty-three patients underwent renovascular intervention (n = 83) and/or renal angiography (n = 40) for suspected renal artery stenosis. Patients with a serum creatinine concentration less than 200 micromol/L (n = 82) were randomized prospectively to receive CO2 with small added amounts of ioxaglate (n = 37) or only ioxaglate (n = 45). Patients with serum creatinine levels greater than 200 micromol/L (n = 41) were not randomized and initially received CO2. Serum creatinine concentrations were measured within 1 day before and 1 day, 2 days, and 2-3 weeks after the procedure. RESULTS: The amount of injected CO2 did not relate to an increase in serum creatinine level. In the randomized groups, and also when the whole patient sample was considered, the amount of injected iodine was significantly correlated (P = .011) with an increase in serum creatinine level and a decrease in estimated creatinine clearance after 2 days. Among the randomized patients, one in the CO2 group and three in the ioxaglate group had a more than 25% increase in serum creatinine level within the first 2 days after the intervention. CONCLUSION: The risk of impairment of renal function is lower after injection of CO2 with small amounts of added ioxaglate compared with injection of a larger amount of ioxaglate alone. The larger the amount of administered iodinated contrast medium, the greater the risk of development of renal failure.

Ort, förlag, år, upplaga, sidor
2005. Vol. 16, nr 1, s. 57-65
Nyckelord [en]
Adult, Aged, Aged; 80 and over, Angiography; Digital Subtraction, Carbon Dioxide/*administration & dosage/adverse effects, Contrast Media/*administration & dosage/adverse effects, Creatinine/blood, Dose-Response Relationship; Drug, Female, Humans, Injections; Intra-Arterial, Ioxaglic Acid/*administration & dosage/adverse effects, Kidney Failure; Acute/prevention & control, Male, Middle Aged, Outcome Assessment (Health Care), Prospective Studies, Renal Artery/radiography, Renal Artery Obstruction/*radiography, Research Support; Non-U.S. Gov't
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:uu:diva-93516DOI: 10.1097/01.RVI.0000144807.81633.79PubMedID: 15640411OAI: oai:DiVA.org:uu-93516DiVA, id: diva2:167013
Tillgänglig från: 2005-09-06 Skapad: 2005-09-06 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
Ingår i avhandling
1. On Renal Artery Stenosis
Öppna denna publikation i ny flik eller fönster >>On Renal Artery Stenosis
2005 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Renal artery stenosis (RAS) is a potentially curable cause of hypertension and azotemia. Besides intra-arterial renal angiography there are several non-invasive techniques utilized to diagnose patients with suspicion of renal artery stenosis. Removing the stenosis by revascularization to restore unobstructed blood flow to the kidney is known to improve and even cure hypertension/azotemia, but is associated with a significant complication rate.

To visualize renal arteries with x-ray techniques a contrast medium must be used. In a randomized, prospective study the complications of two types of contrast media (CO2 and ioxaglate) were compared. CO2 was not associated with acute nephropathy, but induced nausea and had lower attenuation differences compared to Ioxaglate. Acute nephropathy was related to the ioxaglate dose and the risk was evident even at very low doses if the patients were azotemic with creatinine clearance <40 ml/min.

Evaluating patients for clinically relevant renal artery stenosis can be done utilizing several non-invasive techniques. MRA was retrospectively evaluated and shown to be accurate in detecting hemodynamically significant RAS. In a prospective study of 58 patients, evaluated with four methods for renal artery stenosis, it was shown that MRA and CTA were significantly better than ultrasonography and captopril renography in detecting hemodynamically significant RAS. The standard of reference was trans-stenotic pressure gradient measurement, defining a stenosis as significant at a gradient of ≥15 mmHg. The discrepancies were mainly found in the presence of borderline stenosis.

The outcome of percutaneous revascularization procedures showed a technical success rate of 95%, clinical benefit in 63% of treated patients, 30-day mortality 1.5% and major complication rate of 13%. The major complication rate for patients with baseline serum creatinine >300µmol/l was 32%. Our results compare favorably with published studies and guidelines.

Ort, förlag, år, upplaga, sidor
Uppsala: Enheten för radiologi, 2005. s. 54
Nyckelord
Radiology, Renal artery obstruction, Comparative studies, Contrast media, adverse events, Revascularization, Radiologisk forskning
Nationell ämneskategori
Radiologi och bildbehandling
Identifikatorer
urn:nbn:se:uu:diva-5945 (URN)91-506-1824-5 (ISBN)
Disputation
2005-09-30, Enghoffsalen, 50, Akademiska sjukhuset, Uppsala, 13:15
Opponent
Handledare
Tillgänglig från: 2005-09-06 Skapad: 2005-09-06Bibliografiskt granskad

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Liss, PerEklöf, HampusOlsson, UlfHansell, PeterBergqvist, David

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