Use of high-dose gadolinium as contrast media to avoid radiocontrast media-induced nephropathy

Patients at risk for radiocontrast media-induced nephropathy (RCIN) with suspected peripheral vascular disease were evaluated with high-dose (0.4 mmol/kg) gadolinium-based (Gd) contrast angiography (AG). The patients who were considered susceptible to RCIN were defined by having one or more of the following: (1) pre-existing serum creatinine (SCr) >124 micromol/l, (2) diabetes mellitus and (3) age >60 years. An increase in SCr > or = 44 micromol/l or > or = 25% of baseline was considered significant. Ten patients underwent peripheral AG using a high dose of Gd without any adverse reaction. The mean age was 67.8 years. Nine (90%) patients were diabetic. The quality of these images was satisfactory for diagnosis in eight out of 10 patients. None of these patients had significant change in SCr. The mean SCr (+/-SD) before, at 48 hours and at 72 hours after AG were 182 +/- 97, 177 +/- 99 and 177 +/- 98 micromol/l, respectively. Based on this limited study, Gd is a promising agent for peripheral angiographic study. In patients at risk for RCIN, the high dose of Gd appears to be safe without obvious nephrotoxicity.