Systemic and renal hemodynamic effects of intra-arterial radiocontrastReport as inadecuate




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Intensive Care Medicine Experimental

, 2:32

First Online: 16 December 2014Received: 24 April 2014Accepted: 12 November 2014

Abstract

BackgroundDecreased renal blood flow RBF and vasoconstriction are considered major mechanisms of contrast-induced acute kidney injury CIAKI. To understand the severity and duration of such putative effects, we measured systemic and renal hemodynamics after intra-arterial radiocontrast administration. The subjects were six Merino ewes. The setting was a university-affiliated research institute. This is a randomized cross-over experimental study.

MethodsTransit-time flow probes were implanted on the pulmonary and left renal arteries 2 weeks before experimentation. We simulated percutaneous coronary intervention by administering five intra-arterial boluses of 0.5 mL-kg saline control or radiocontrast iodixanol to a total of 2.5 mL-kg over 1 h. Cardiac output CO, heart rate, mean arterial pressure MAP, RBF, renal vascular conductance RVC, urine output UO, creatinine clearance CrCl, and fractional excretion of sodium FENa were measured.

ResultsIn the first 8 h after intra-arterial administration of radiocontrast, CO, total peripheral conductance TPC, and heart rate HR increased compared with those after normal saline administration. Thereafter, CO and TPC were similar between the two groups, but HR remained higher with radiocontrast p < 0.001. After a short 30 min period of renal vasoconstriction with preserved RBF secondary to an associated increase in MAP, RBF and RVC showed an earlier and greater increase vasodilatation with radiocontrast p < 0.001 and remained higher during the first 2 days. Radiocontrast initially increased urine output p < 0.001 and FENa p = 0.003. However, the overall daily urine output decreased in the radiocontrast-treated animals at 2 days p < 0.001 and 3 days p = 0.006. Creatinine clearance was not affected.

ConclusionsIn healthy animals, intra-arterial radiocontrast increased RBF, induced renal vasodilatation, and caused a delayed period of oliguria. Our findings suggest that sustained reduction in RBF and renal vasoconstriction may not occur in normal large mammals after intra-arterial radiocontrast administration.

KeywordsRadiocontrast agent Angiography Contrast-induced acute kidney injury Renal vascular resistance Vasoconstriction Renal blood flow Iodixanol Electronic supplementary materialThe online version of this article doi:10.1186-s40635-014-0032-z contains supplementary material, which is available to authorized users.

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Author: Paolo Calzavacca - Ken Ishikawa - Michael Bailey - Clive N May - Rinaldo Bellomo

Source: https://link.springer.com/







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