Advanced

Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

Nyman, Ulf LU ; Almén, Torsten LU ; Jacobsson, Bo and Aspelin, Peter (2012) In European Radiology 22(6). p.1366-1371
Abstract
We oppose the opinion that the intra-arterial administration of iodine-based contrast media (CM) appears to pose a greater risk of contrast medium-induced nephropathy (CIN) than intravenous administration since 1) in intra-arterial coronary procedures and most other intra-arterial angiographic examinations, CM injections are also intravenous relative to the kidneys, 2) there is a lack of comparative trials studying the risk of CIN between intra-arterial and intravenous procedures with matched risk factors and CM doses, 3) a bias selection of patients with fewer risk factors may explain the seemingly lower rate of CIN after CT in comparison with coronary interventions, 4) the rate of CIN following intra-arterial coronary procedures may also... (More)
We oppose the opinion that the intra-arterial administration of iodine-based contrast media (CM) appears to pose a greater risk of contrast medium-induced nephropathy (CIN) than intravenous administration since 1) in intra-arterial coronary procedures and most other intra-arterial angiographic examinations, CM injections are also intravenous relative to the kidneys, 2) there is a lack of comparative trials studying the risk of CIN between intra-arterial and intravenous procedures with matched risk factors and CM doses, 3) a bias selection of patients with fewer risk factors may explain the seemingly lower rate of CIN after CT in comparison with coronary interventions, 4) the rate of CIN following intra-arterial coronary procedures may also be exaggerated owing to other causes of acute kidney failure, such as haemodynamic instability and microembolisation, 5) roughly the same gram-iodine/GFR ratio (≈1:1) as a limit of relatively safe CM doses has preliminarily been found for both intravenous CT and intra-arterial coronary procedures and 6) the substantially higher injected intravenous CM dose rate during CT relative to an intra-arterial coronary procedure might actually pose a higher risk of CIN following CT. Key Points • Most intra-arterial injections of contrast media are intravenous relative to the kidneys.• No evidence that intravenous CM injections should be less nephrotoxic than intra-arterial.• Considerably higher dose rates of CM are used for CT relative to intra-arterial procedures.• Higher dose rates may pose higher nephrotoxic risk for intravenous based CT studies. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Radiology
volume
22
issue
6
pages
1366 - 1371
publisher
Springer
external identifiers
  • wos:000303876100027
  • pmid:22307815
  • scopus:84861526852
ISSN
0938-7994
DOI
10.1007/s00330-011-2371-4
language
English
LU publication?
yes
id
fdfcd91e-47db-44ee-a4c1-92a6e8f78f38 (old id 2367227)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22307815?dopt=Abstract
date added to LUP
2012-03-02 09:11:09
date last changed
2017-11-12 04:09:21
@article{fdfcd91e-47db-44ee-a4c1-92a6e8f78f38,
  abstract     = {We oppose the opinion that the intra-arterial administration of iodine-based contrast media (CM) appears to pose a greater risk of contrast medium-induced nephropathy (CIN) than intravenous administration since 1) in intra-arterial coronary procedures and most other intra-arterial angiographic examinations, CM injections are also intravenous relative to the kidneys, 2) there is a lack of comparative trials studying the risk of CIN between intra-arterial and intravenous procedures with matched risk factors and CM doses, 3) a bias selection of patients with fewer risk factors may explain the seemingly lower rate of CIN after CT in comparison with coronary interventions, 4) the rate of CIN following intra-arterial coronary procedures may also be exaggerated owing to other causes of acute kidney failure, such as haemodynamic instability and microembolisation, 5) roughly the same gram-iodine/GFR ratio (≈1:1) as a limit of relatively safe CM doses has preliminarily been found for both intravenous CT and intra-arterial coronary procedures and 6) the substantially higher injected intravenous CM dose rate during CT relative to an intra-arterial coronary procedure might actually pose a higher risk of CIN following CT. Key Points • Most intra-arterial injections of contrast media are intravenous relative to the kidneys.• No evidence that intravenous CM injections should be less nephrotoxic than intra-arterial.• Considerably higher dose rates of CM are used for CT relative to intra-arterial procedures.• Higher dose rates may pose higher nephrotoxic risk for intravenous based CT studies.},
  author       = {Nyman, Ulf and Almén, Torsten and Jacobsson, Bo and Aspelin, Peter},
  issn         = {0938-7994},
  language     = {eng},
  number       = {6},
  pages        = {1366--1371},
  publisher    = {Springer},
  series       = {European Radiology},
  title        = {Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?},
  url          = {http://dx.doi.org/10.1007/s00330-011-2371-4},
  volume       = {22},
  year         = {2012},
}