Gadolinium-based contrast agents and nephrotoxicity in patients undergoing coronary artery procedures

Catheter Cardiovasc Interv. 2006 Feb;67(2):175-80. doi: 10.1002/ccd.20592.


Objective: We tested whether gadolinium-based contrast agent is less nephrotoxic than iodinated-contrast media.

Background: Iodinated contrast agents are nephrotoxic. Some data suggest that gadolinium-based contrast agent may be less nephrotoxic than iodinated-contrast media.

Methods: Twenty-five consecutive patients with chronic renal insufficiency (creatinine concentration > or = 2.0 mg/dl and/or clearance < or = 40 ml/min), referred to our institution for coronary procedures, were assigned to receive gadolinium-based contrast agents, a solution of gadolinium chelates diluted 3:1 by iso-osmolality contrast media (Gadolinium-based group). A control group of 32 patients with comparable clinical characteristics and treated with iodinated iso-osmolality contrast agent alone (Iodinated-based group) was selected from our database and compared with the Gadolinium-based group. In all cases, prophylactic administration of 0.45% saline intravenously and NAC (1200 mg orally twice daily) was used.

Results: Baseline creatinine levels and creatinine clearance were similar in the 2 groups (Gadolinium-based group = 2.30 [IQR: 2.01-2.68] mg/dl and 33 +/- 13 ml/min; Iodinated-based group = 2.24 [IQR: 2.05-2.65] mg/dl and 30 +/- 10 ml/min; P > 0.05 for all). Increase of at least 0.5 mg/dl of the creatinine concentration 48 hr after the procedure occurred in 7/25 (28%) patients in the Gadolinium-based group and in 2/32 (6.5%) patients in the Iodinated-based group (P = 0.034; OR = 4.48; 95% CI = 1.01-19.17). Renal failure requiring temporary dialysis occurred in 2 (8%) patients in the Gadolinium-based group and in none in the Iodinated-based group (P = 0.19).

Conclusions: The strategy of gadolinium-based contrast agent administration does not seem to reduce the rate of CAN, as compared to the iodinated iso-osmolality contrast agent in patients with chronic renal insufficiency.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Chi-Square Distribution
  • Contrast Media / adverse effects*
  • Coronary Angiography*
  • Creatinine / urine
  • Female
  • Gadolinium DTPA / adverse effects*
  • Humans
  • Kidney Diseases / chemically induced*
  • Kidney Failure, Chronic / physiopathology
  • Logistic Models
  • Male
  • Organometallic Compounds / adverse effects*
  • Pilot Projects
  • Retrospective Studies
  • Statistics, Nonparametric
  • Triiodobenzoic Acids / adverse effects


  • Contrast Media
  • Organometallic Compounds
  • Triiodobenzoic Acids
  • gadobutrol
  • gadodiamide
  • Creatinine
  • iodixanol
  • Gadolinium DTPA