Kane Garvan C, Stanson Anthony W, Kalnicka Dita, Rosenthal David W, Lee Christine U, Textor Stephen C, Garovic Vesna D
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Nephrol Dial Transplant. 2008 Apr;23(4):1233-40. doi: 10.1093/ndt/gfm725. Epub 2008 Feb 5.
Percutaneous angiography with iodinated contrast in patients with chronic kidney disease carries a risk of contrast nephropathy, which is independently associated with renal disease progression and increased mortality. Gadolinium contrast is a potential alternative to iodinated contrast for percutaneous transluminal renal angioplasty (PTRA), and appears to be safe and well tolerated. The aim of this study was to assess the results of gadolinium use to facilitate PTRA in patients with chronic kidney disease.
Clinical outcomes were compared between patients with serum creatinine (Cr) >/= 176 micromol/L (2 mg/dL), who had either gadolinium (n = 57; gadoteridol or gadodiamide), iodinated (n = 68; iohexol or iodixanol) or a combination of gadolinium and iodinated-contrast-enhanced (n = 38) PTRA.
Despite similar degrees of pre-procedural renal insufficiency, the incidence of immediate contrast nephropathy [defined as an increase in serum Cr of 44 micromol/L (0.5 mg/dL) within 7 days without other identifiable causes] was lowest in the gadolinium group (3/57, 5.3%) compared to those receiving a combination of modest iodinated contrast in addition to gadolinium (4/38, 10.5%) or solely iodinated contrast (14/68, 20.6%). This was associated with a reduction in the 30-day progression to need for renal replacement therapy (RRT) (P < 0.005). Yet, over a mean follow-up of 40 +/- 22 months, renal function outcomes or all-cause mortality were not different between the contrast groups. The type of contrast used had no effect on technical success and both short- and long-term blood pressure outcomes were comparable between the groups. Two patients developed pathology-proven nephrogenic fibrosing dermopathy, a serious skin condition that has been seen in patients with kidney disease following administration of gadolinium.
Gadolinium contrast appears to be an effective agent for interventional renal angiograms. Compared to iodinated contrast, gadolinium contrast is associated with a significantly lower incidence of contrast nephropathy and early progression to end-stage renal disease (ESRD) in patients with pre-existing chronic kidney disease. The risk of fibrosing dermopathy however and remains to be established.
慢性肾病患者进行含碘造影剂的经皮血管造影存在造影剂肾病风险，这与肾病进展及死亡率增加独立相关。钆造影剂是经皮腔内肾血管成形术（PTRA）中碘造影剂的一种潜在替代物，且似乎安全且耐受性良好。本研究的目的是评估钆造影剂用于促进慢性肾病患者PTRA的效果。
比较血清肌酐（Cr）≥176微摩尔/升（2毫克/分升）的患者的临床结局，这些患者接受了钆造影剂（n = 57；钆特醇或钆双胺）、碘造影剂（n = 68；碘海醇或碘克沙醇）或钆造影剂与碘造影剂联合增强（n = 38）的PTRA。
尽管术前肾功能不全程度相似，但钆造影剂组即刻造影剂肾病（定义为7天内血清Cr升高44微摩尔/升（0.5毫克/分升）且无其他可识别原因）的发生率最低（3/57，5.3%），相比接受钆造影剂加适量碘造影剂联合使用的患者（4/38，10.5%）或仅接受碘造影剂的患者（14/68，20.6%）。这与30天内进展至需要肾脏替代治疗（RRT）的情况减少相关（P < 0.005）。然而，在平均40±22个月的随访中，各造影剂组之间的肾功能结局或全因死亡率并无差异。所用造影剂类型对技术成功率无影响，且两组之间的短期和长期血压结局具有可比性。两名患者发生了经病理证实的肾源性纤维化皮肤病，这是一种在肾病患者使用钆造影剂后出现的严重皮肤疾病。
钆造影剂似乎是介入性肾血管造影的有效药物。与碘造影剂相比，钆造影剂在已有慢性肾病的患者中，造影剂肾病的发生率以及早期进展至终末期肾病（ESRD）的发生率显著更低。然而，纤维化皮肤病的风险仍有待确定。
