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Cardiovascular and Renal Toxicity of a Nonionic Radiographic Contrast Agent after Cardiac Catheterization: A Prospective Trial

Charles J. Davidson, MD; Mark Hlatky, MD; Kenneth G. Morris, MD; Karen Pieper, MS; Thomas N. Skelton, MD; Steve J. Schwab, MD; and Thomas M. Bashore, MD
[+] Article, Author, and Disclosure Information

Grant Support: Partial support by Squibb Diagnostics, Inc.; grant HL36587 from the National Heart, Lung, and Blood Institute, National Institutes of Health; grant HS-05635 from the National Center for Health Services Research; and the Robert Wood Johnson Foundation.

Requests for Reprints: Thomas M. Bashore, MD, Box 3012, Duke Medical Center, Durham, NC 27710.

Current Author Addresses: Drs. Davidson, Hlatky, Skelton, Schwab, and Bashore, and Ms. Pieper: Duke University Medical Center, Durham, NC 27710.

Dr. Morris: Veterans Administration Medical Center, Durham, NC 27710.

©1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;110(2):119-124. doi:10.7326/0003-4819-110-2-119
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Study Objective: To determine the incidence of cardiovascular and renal toxicity of a nonionic contrast agent when used for cardiac catheterization, and to assess the value of electrolytes and urinalysis results as predictors of nephropathy induced by a contrast agent.

Study Design: Nonrandomized trial using a criterion standard and a cohort analytic study with a 48-hour follow-up.

Setting: Referral-based university hospital.

Patients: Convenience sample of patients having diagnostic cardiac catheterization. Renal function and clinical status were evaluated at baseline in 1144 patients; at 24 hours in 1077 (94%); and at 48 hours in 663 (57%).

Interventions: After patients received saline for hydration, coronary angiography and left ventriculography were done with iopamidol (average dose, 203 ± 56 cc).

Measurements and Main Results: The definite and possible incidence of major acute cardiovascular complications from nonionic contrast media was 0.2% and 0.7%, respectively. The mean serum creatinine level increased 11.5 μ/L from baseline at 24 hours (P < 0.0001) nd 16.8 μ/L from baseline at 48 hours (P < 0.0001). Results in a randomly selected training sample were studied to determine predictors of a rise in serum creatinine of 44.2 μ.mol/L or more. The baseline serum creatinine level and age were significant predictors of renal injury, but hypertension, diabetes mellitus, congestive heart failure, vascular disease, the volume of contrast agent injected or baseline values of urinary variables did not predict nephrotoxicity. In an independent validation sample, only the baseline serum creatinine level was confirmed as a predictor of nephrotoxicity, whereas age was not. A model that predicted contrast-induced nephropathy by the serum creatinine level showed an exponential increase in the risk for nephrotoxicity if the baseline level was 106.1 μmol/L or higher.

Conclusions: Patients have a small but significant rise in serum creatinine after cardiac catheterization with a nonionic contrast agent. Baseline renal insufficiency is the only confirmed predictor of nonionic contrast-induced nephrotoxicity.





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