The Use of Ionic and Nonionic Contrast Agents and the Effects of Hydration in the Post Cardiac Transplant Patient with Moderate Renal Insufficiency

Abstract

To determine the effects of ionic (diatrizoate) and nonionic (iopamidol) con trast and of hydration, 90 asymptomatic cyclosporine-treated cardiac transplant patients with moderate renal insufficiency (serum creatinine ≥1.5 mg/dL) under going cardiac catheterization were evaluated. All patients were hydrated with intravenous fluid (5% dextrose and 0.5 normal saline) over a twelve-hour period prior to catheterization and with oral fluids thereafter. Thirty patients received iopamidol (Group I) and 60 were given diatrizoate (Group II). Renal function was determined the day before and after catheterization in all patients of Group I and in 30 patients of Group II (Group IIa). In the remaining 30 patients of Group II renal function was also determined before contrast administration (Group IIb). The dose of dye was similar in all groups (I: 139±55 mL, IIa: 140±58 mL, IIb: 128 ± 38 mL). There was a significant decrease in BUN (I: 41±10 to 33±8 mg/dL [p<0.005], IIa: 42±9 to 33±8 mg/dL mg/dL [p<0.001], IIb: (44±12 to 34±10 mg/dL [p<0.005]) and a small decrease in serum cratinine after catheterization (I:2.0±0.3 to 1.9±0.3 mg/dL, IId:2.0±0.3 to 1.9±0.3 mg/dL, IIb:2.1±0.4 to 1.8±0.4 mg/dL [p<0.005]. In Group IIb patients there was a significant decrease in BUN (44±12 to 36 ± 12 mg/dL [p<0.01]) and creatinine (2.1 ± 0.4 to 1.8±0.4 mg/dL [p<0.005]) after hydration. There were no additional changes twenty-four hours after receipt of contrast in this group. When adequately hydrated, cyclosporine-treated cardiac transplant patients do not exhibit worsening of renal insufficiency with either contrast agent and therefore either can be used safely in this setting.