Gadolinium Contrast Media Are More Nephrotoxic Than Iodine Media. The Importance of Osmolality in Direct Renal Artery Injections

Eur Radiol. 2006 Dec;16(12):2712-20. doi: 10.1007/s00330-006-0357-4. Epub 2006 Aug 5.

Abstract

A study was undertaken of the role of osmotoxicity in gadolinium (Gd) and iodine contrast media (CM) nephrotoxicity in ischemic porcine kidneys. Test solutions: mannitol iso-osmotic to 0.5 M: gadopentetate (1.96 Osm/kg H2O), 0.5 M: gadodiamide (0.78 Osm/kg H2O) and 0.5 M: iohexol (190 mg I/ml, 0.42 Osm/kg H2O). Each solution was injected [3 ml/kg body weight (BW)] into the balloon-occluded (10 min) renal artery of eight left-sided nephrectomized pigs. The plasma half-life of a glomerular filtration rate (GFR) marker was used to compare their effects on GFR 1-3 h post-injection. The median half-lives of the GFR marker after injection of gadopentetate (1,730 min) and mannitol 1.96 Osm/kg H2O (2,782 min) did not differ statistically (P = 0.28), but were significantly longer than after all other solutions (P < 0.001). There was no significant difference (P = 0.06) between gadodiamide (218 min) and mannitol 0.82 Osm/kg H2O (169 min), while there was (P = 0.03) between iohexol (181 min) and mannitol 0.43 Osm/kg H2O (148 min). The difference between gadodiamide and iohexol was significant (P = 0.01). Reduction in GFR, as a marker of nephrotoxicity, induced by gadopentetate correlated with its high osmolality, while the effect of gadodiamide and iohexol may include chemotoxicity. Iohexol molecules were less nephrotoxic than the Gd-CM molecules and contain three-times the number of attenuating atoms per molecule.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Contrast Media / pharmacokinetics
  • Contrast Media / toxicity*
  • Gadolinium DTPA / pharmacokinetics
  • Gadolinium DTPA / toxicity*
  • Glomerular Filtration Rate
  • Half-Life
  • Injections
  • Iohexol / pharmacokinetics
  • Iohexol / toxicity*
  • Kidney Diseases / chemically induced*
  • Male
  • Mannitol / pharmacokinetics
  • Mannitol / toxicity
  • Osmolar Concentration
  • Renal Artery
  • Statistics, Nonparametric
  • Swine

Substances

  • Contrast Media
  • Mannitol
  • Iohexol
  • gadodiamide
  • Gadolinium DTPA