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Renal effects of CO2 and iodinated contrast media in patients undergoing renovascular intervention: a prospective, randomized study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
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2005 (English)In: Journal of Vascular and Interventional Radiology, ISSN 1051-0443, E-ISSN 1535-7732, Vol. 16, no 1, 57-65 p.Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
2005. Vol. 16, no 1, 57-65 p.
Keyword [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
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-93516DOI: 10.1097/01.RVI.0000144807.81633.79PubMedID: 15640411OAI: oai:DiVA.org:uu-93516DiVA: diva2:167013
Available from: 2005-09-06 Created: 2005-09-06 Last updated: 2017-12-14Bibliographically approved
In thesis
1. On Renal Artery Stenosis
Open this publication in new window or tab >>On Renal Artery Stenosis
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Uppsala: Enheten för radiologi, 2005. 54 p.
Keyword
Radiology, Renal artery obstruction, Comparative studies, Contrast media, adverse events, Revascularization, Radiologisk forskning
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-5945 (URN)91-506-1824-5 (ISBN)
Public defence
2005-09-30, Enghoffsalen, 50, Akademiska sjukhuset, Uppsala, 13:15
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Available from: 2005-09-06 Created: 2005-09-06Bibliographically approved

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Liss, PerEklöf, HampusOlsson, UlfHansell, PeterBergqvist, David

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