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

作者：Nyman Ulf^*; Almen Torsten; Jacobsson Bo; Aspelin Peter

来源：European Radiology, 2012, 22(6): 1366-1371.

DOI：10.1007/s00330-011-2371-4

• Angiography
• Acute kidney injury
• Computed tomography
• Contrast media
• Renal insufficiency

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 (a parts per thousand 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. %26lt;br%26gt;Key Points %26lt;br%26gt;Most intra-arterial injections of contrast media are intravenous relative to the kidneys. %26lt;br%26gt;No evidence that intravenous CM injections should be less nephrotoxic than intra-arterial. %26lt;br%26gt;Considerably higher dose rates of CM are used for CT relative to intra-arterial procedures. %26lt;br%26gt;Higher dose rates may pose higher nephrotoxic risk for intravenous based CT studies.

• 出版日期2012-6