Frequency and determinants of adverse reactions induced by high-osmolality contrast media.

Abstract

To determine the frequency of and risk factors for adverse reactions to high-osmolality contrast media, the authors prospectively studied hospitalized patients undergoing cardiac catheterization. The authors also studied patients undergoing peripheral angiography and contrast material-enhanced computed tomography (CT) of the head or body who met at least one of the following criteria thought to increase the risk of adverse reactions: age of more than 60 years, diabetes, renal or liver disease, concurrent nephrotoxic drug use, or a history of allergic reactions (n = 795). Criteria were defined and used to group adverse reactions into three classes of clinical severity. Overall, class I (mild), class II (moderate), and class III (severe) reactions occurred in 362 (45%), 44 (5.5%), and three (0.4%) patients, respectively. Class II reactions were relatively common (25%) in patients undergoing cardiac catheterization yet were uncommon (2%) in patients undergoing the other three procedures. Nephrotoxicity occurred in 18 of 651 patients who had follow-up creatinine levels obtained at 48-72 hours. With multivariate regression analysis, the only risk factor (P less than .05) for combined class II and III reactions was diabetes. Diabetes, furosemide use, and a history of atopy (odds ratio = 2.8) were associated with nephrotoxicity (P less than .05). Underlying renal insufficiency was not a risk factor for nephrotoxicity.

Comparison of Iodixanol and Iohexol in Patients Undergoing Intravenous Pyelography: A Prospective Controlled Study

“…[30,31] Late reactions are reported with frequencies of between 8.7% and 70.0%, [34][35][36][37] and reports have also suggested that there is an increased frequency of late reaction with non-ionic dimeric CM compared to non-ionic monomeric CM. [31] The physiological background of late reaction is unknown.…”

“…The use of aggressive hydration strategies before contrast infusion has been shown to be important in preventing CN. Severe complications in the high-risk patients, including adverse reactions of CM, [29][30][31] may be managed by hemodialysis. [28] In the past, non-ionic monomers and dimmers have both been shown to have a good safety profile in normal subjects.…”

Contrast-Induced Nephropathy

“…Sepsis, through direct damage by bacterial toxins to renal tubules and impairment of circulation, has also been reported as a risk factor, as have hypertension, peripheral vascular disease, and atopic allergy [9,27,82].…”

Oral administration of iopentol (Imagopaque® 300 mg I/ml) compared with amidotrizoate (Peritrast® 300 mg I/ml), both diluted to 2 % (v/v), in imaging of the gastrointestinal tract in abdominal contrast enhanced CT A clinical trial assessing patient tolerance, distribution of contrast medium and Hounsfield unit measurements

“…Recent experimental and clinical data show that much less tissue damage occurs following extravasation of non-ionic contrast medium [8]. Non-ionic contrast media are generally better tolerated [9][10][11]. Many patients do not accept the taste of Gastrografin (diatrizoate) when drinking a large volume.…”