NDT Advance Access originally published online on January 5, 2008
Nephrology Dialysis Transplantation 2008 23(5):1588-1594; doi:10.1093/ndt/gfm835
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Acute renal haemodynamic effects of radiocontrast media in patients undergoing left ventricular and coronary angiography
1 Department of Cardiology, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Berlin, Germany 2 Clinical Centre of Serbia, Clinic of Nephrology, School of Medicine, University of Belgrade, Belgrade, Serbia and Montenegro 3 Department of Nephrology and Medical Intensive Care, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Berlin, Germany 4 Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany
Correspondence and offprint requests to: Martin Möckel, Department of Cardiology, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Tel: +49-30-450-553472; Fax: +49-30-450-553927; E-mail: martin.moeckel{at}charite.de
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Abstract |
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Background. Tubular toxicity and renal ischaemia have been implicated in the pathogenesis of radiocontrast media induced nephropathy (CIN), but their respective role remains unclear.
Aims. In order to evaluate changes in renal blood flow in response to intra-arterial contrast media administration, we aimed to continuously measure renal arterial perfusion by means of renal blood flow velocity (RBFV) during left ventricular and coronary angiography and subsequent coronary intervention in patients with chronic kidney disease (CKD).
Patients and Methods. Ten patients (7 males, 63.4 ± 11.7 years) with serum creatinine (SCr) >1.5 mg/dl participated in the study. The first five patients received low-osmolar iopromide and the others iso-osmolar iodixanol contrast medium. RBFV was measured using a 0.014-inch Doppler guide wire, which was inserted through a separate contralateral femoral sheath via a 5 F Cobra diagnostic catheter into the renal artery. Data were recorded at 500 Hz to allow beat-to-beat analysis of RBFV and pressure. All patients were pre-treated with acetylcysteine and hydration.
Results. Immediately after left ventricular angiography no significant changes in RBFV were detected. Over time, however, following repeated administration of the additional contrast medium into the coronary arteries, RBFV decreased significantly from baseline until the end of the investigation, 28.4 (19.1/42.7) to 22.9 (16.9/30.6) cm/s (median and quartiles; P = 0.005), in the absence of significant changes in systemic arterial blood pressure. In individual patients the reduction in RBVF varied from 3.7% to 39.5%. On average the decline in RBFV was more pronounced in patients receiving iopromide (from 41.6 cm/s to 29.3 cm/s) than in those receiving iodixanol (from 19.3 to 17.8 cm/s; P = 0.008 for the difference of relative decline). However, in the iopromide treated patients, coronary intervention was more frequently performed (5/5 versus 2/5) and the median duration of the procedure tended to be longer [85 (32–150) min versus 38 (27–110) min; P > 0.2].
Conclusions. The administration of non-ionic low-osmolal contrast media has no immediate effect on renal perfusion in patients with CKD. However, during the course of coronary angiography a gradual decline in renal blood flow may occur, the extent of which varies, presumably depending on individual pre-disposition as well as on the amount of the contrast medium.
Keywords: acute renal failure; coronary angiography; iodixanol; iopromide; renal artery blood flow velocity
Received for publication: 23. 8.07
Accepted in revised form: 25.10.07