Acta Radiologica

ISSN: 0284-1851 (Print) 1600-0455 (Online) Journal homepage: http://www.tandfonline.com/loi/iard20

Effects of the Low-Osmolality Contrast Medium

Ioversol (Optiray) on Renal Function in a Geriatric
Population
J.-P. Louvel, E. Primard, J. Henry, C. Houlette, A. Weinstein & A. Janvresse
To cite this article: J.-P. Louvel, E. Primard, J. Henry, C. Houlette, A. Weinstein & A. Janvresse
(1996) Effects of the Low-Osmolality Contrast Medium Ioversol (Optiray) on Renal Function in a
Geriatric Population, Acta Radiologica, 37:6, 950-953
To link to this article: http://dx.doi.org/10.3109/02841859609175475

Published online: 07 Jan 2010.

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Copyright 0 Acta Radiologica 1996

Acta Radiologica 37 (1996) 950-953

Printed in Denmark . All rights reserved

A CTA R A D I O LOG1 CA
ISSN 0284-18.51

EFFECTS OF THE LOW-OSMOLALITY CONTRAST MEDIUM

IOVERSOL (OPTIRAY) ON RENAL FUNCTION IN A GERIATRIC
POPULATION
J.-P. LOWEL',E. PIUMARD',
J. HENRY^, C. HOULETTE~,
A. WE IN STEIN^ and A. JANVRESSE'

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'Service d'Imagerie MCdicale, H6pital de Bois Guillaume, CHRU Rouen; and 2Service de Radiologie Adulte, CHG Le Havre; France.

Abstract
Purpose: To assess the incidence of nephrotoxicity following i.v. injection of the iodinated low-osmolality contrast medium ioversol 300 (Optiray) in a geriatric population compared with a control group aged under 60 years, neither group presenting any
associated risk factors.
Material and Methods: CT with i.v. bolus injection of ioversol300 mg I/ml was performed at a mean dose of 1.36M.06 m l k g (range 1-2 m l k g b.w.) in 47 patients aged
over 69 years. Serum creatinine level was measured and creatinine clearance was calculated at 24, 48 and 72 h after the examination, and compared to a reference serum
creatinine value taken before CT. The findings were compared with a control group of
44 patients aged under 60 years.
Results: No significant increase in serum creatinine (+0.6 mmoV1) or in creatinine
clearance (+0.7 ml/min) was found during the course of 3 days after the injection. Only
one patient (aged 82) presented an increase of 25% in serum creatinine (109 mmolll).
Conclusion: The trial did not demonstrate any significant difference between the 2
groups, although the elderly patients had a subclinical renal impairment revealed by the
decrease of the initial creatinine clearance. The use of low-osmolality ioversol makes
it possible to perform examination with an iodinated contrast agent without increasing
the incidence of nephrotoxicity in elderly subjects.

The mean increase in life expectancy is linked in

part to the diagnostic and therapeutic progress
achieved in the geriatric population. It is therefore
important to reduce the morbidity related to diagnostic investigations, particularly the nephrotoxicity
of contrast agents.
In review articles and retrospective studies (4, 5,
17), geriatric patients are considered to be at risk of
developing contrast nephrotoxicity (CN). However,
RICH& CRECELIUS
(16) evaluated the onset of CN in
elderly individuals after cardiac angiography to be
between 1.2 and 60% depending on absence or presence of several risk factors, values that they considered to be comparable to those observed in a
younger population.
950

Key words: Renal function, contrast media; CT, toxicity; ioversol.

Correspondence: Jean-Pierre Louvel,
Service d'Imagerie MCdicale,
HBpital de Bois Guillaume, CHRU
Rouen, F-7603 1 Rouen Cedex, France.
FAX *33 35 60 70 29.
I

Accepted for publication 14 February

1996.

Regardless of these conflicting assessments, examinations involving the injection of a contrast

agent should be carried out with extreme caution in
geriatric patients. It is generally accepted that the
use of low-osmolality contrast ,media (LOCM) reduces the incidence of CN, particularly in high-risk
groups and more specifically in patients with preexisting renal insufficiency and diabetes mellitus (2,
3, 8-10).
The incidence of CN due to LOCM in elderly
subjects not presenting any other known risk factor
has not been established. The aim of this study was
to assess the degree of CN following the administration of a LOCM, ioversol300 (Optiray, Guerbet), in
a geriatric population compared with a control

IOVERSOL EFFECT ON RENAL FUNCTION IN A GERIATRIC POPULATION

Table 1

Table 2

Main characteristics of the 2 patient groups

S, and creatinine clearance before and after examination

Age, years
Height, cm
Weight, kg
s, mm0M
Creatinineclearance, mYmin
Dose, mVkg

Group 1,
>69 years

Group 2,
<60 years

77.9f5.8
162.3f6.8
62.1f1.8
85.122.9
53.71f2.8*
1.36*.06

46.2f1.0
168.7f8.8
69.652.1
82.1f2.3
97.09f6.6*
1.39iO.08

*p<o.O001.

group aged under 60 years, neither group presenting

any associated risk factors.

Group 1,
>69 years

Group 2,
<60 years

Scr mmol
Before examination
After 24 h
After 48 h
After 72 h

85.1f2.9
85.5f3.1
86.3f3.2
85.6f3.6

829k2.3
79.7f2.4
80.8f2.4
78.5f2.5

Creatinine clearance, mumin

Before examination
After 24 h
After 48 h
After 72 h

53.71f2.8
54.75L3.3
53.6253.1
54.58f3.4

97.09f3.6
103.3W4.1
101.59f4.4
102.68f4.0

Table 3

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Material and Methods

Ninety-one consecutive hospitalised patients were

included in the study and divided into 2 groups (Table 1): one group (group 1) comprising 47 patients
aged over 69 years (mean age 77.9 years) and one
control group (group 2) comprising 44 patients aged
under 60 years (mean age 46.2 years). The inclusion
criteria were: a) hospitalisation scheduled for at least
3 days following the examination; b) initial serum
creatinine (Scr) level of less than 120 mmoVl (measured not more than 48 h previously); c) no exploration with an iodinated contrast agent within 8 days
preceding the examination; d) no diabetes, myeloma, dehydration or unstable haemodynamic status;
and e) the informed written consent of the patients.
CT with i.v. bolus injection of ioversol300 mg I/
ml (Optiray) at a mean dose of 1.36k0.06 mlkg b.w.
(range 1-2 mvkg) in group 1 and 1.39k0.08 (range
1-2 mvkg) in group 2 (no significant inter-group
difference) was performed. S,, was measured 24,48
and 72 h after CT (T24, T48, T72).
Creatinine clearance was calculated on the basis
&
of weight, sex and age according to the COCKROFT
GAULT
formula (6). An increase in S,, of over 25%
from baseline was considered a possible reflexion of
CN (9, 10).
Statistical analysis. We used a 2-way analysis of
variance (centre and treatment) for repeated measures for the quantitative variables measured at
several different times, and a Fischer test for the
qualitative variables.
All statistical tests used were bilateral and the
level of significance was set at 0.05.
Results

The results (Table 2) did not show any significant

difference between preinjection S,, or creatinine

Maximum relative change in creatinine

Group 1, >69 years

Group 2, <60 years

Mean,
Tx-TOR0

SD

47

-0.049
-0.022

0.154
0.149

44

clearance values and those observed 24,48 and 72 h

postinjection.
The maximum differences in S,, means occurred
in both groups at 72 h: 4 . 7 mmoVl in group 2 and +
0.5 mmol/l in group 1.
Individual analysis of the 91 cases showed only
one increase in S, equivalent to 25% (87 mmom109 mmoM), in an 82-year-old patient. A rapid improvement was observed in this patient.
An increase of over 10% in S,, was observed in 8
patients in group 1 and 4 patients in group 2; this
difference was not significant.
In order to evaluate the maximum relative change
(Tx-TO)/TO in S,, after the injection, the value
among the 3 T24, T48, and T72 measurements deviating most from the baseline value (TO) was selected
for each patient (Table 3). It demonstrated that the
creatinine showed a tendency to decrease in both
groups (decrease of 5% in group 1 versus 2% in
group 2). The difference between the groups was not
significant.
The maximum increase in creatinine was approximately 8% in both groups with no significant intergroup difference (Table 4).
Discussion

CN has been estimated to account for as much as

12% of hospital-acquired renal failure (10). The rate
( 0 4 0 % )of CN among contrast media procedures
varies because of the different criteria defining a sig951

J.-P. LOUVEL ET AL.

Table 4
Maximum relative positive change in creatinine

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Group 1, >69 years

Group 2, <60 years

Mean

SD

Minimum

Median Q2

29
31

0.085

0.064

0.069

0.083

0.072

0.065

nificant change in renal function (2, 16, 17), and because of the presence of different risk factors.
Injection of contrast media induces a typical biphasic effect: the transient increase in renal blood
flow followed by a more sustained vasoconstriction.
Many mediators have been proposed to account for
this vasoconstrictive effect (11, 15). Contrast media
also induce medullar hypoperfusion (3). This medullary hypoperfusion is opposed to the osmolalityrelated increase in tubular 0, demand. Therefore reversible renal dysfunction or histological tubular
necrosis could occur. Moreover, NYGREN
(13) suggested that contrast media effects on blood rheology
could play a role in the blood flow discrepancy. Direct tubular toxicity has also been discussed; enzymuria and tubular cytoplasmic vacuolisation (1I),
which follow contrast injection, are taken as evidence of a direct tubular toxicity, but their significance remains to be demonstrated
Although diabetes mellitus and pre-existing renal
insufficiency have been identified as risk factors for
the development of CN (14), other causes are more
controversial, particularly the age of the patients.
Some authors found no correlation between aging
and CN (16, 18). LINDEMAN
et al. (12) showed the
decrease in glomerular filtration to be due to the
presence of disease and that aging itself does not
provoke a change. These findings are supported by
experimental studies in the rat which did not identify any age-dependent fall in glomerular filtration
(7). Others consider aging to be an independent risk
factor (4,5). The incidence of sclerotic glomeruli increases with advancing age, so that sclerosis involves up to nearly 40% of the total glomerular population in the 8th decade (1).
Therefore several functional effects also occur as
alteration in renal blood flow with decrease in the
glomerular filtration rate.
The glomerular filtration rate declines in a linear
manner by about 8 mVmin per decade (3,with an
average level of 60 mumin by the 7th decade.
Although a moderate renal insufficiency was not
eliminated (because the geriatric group studied was
suffering from a subclinical renal impairment), with
a mean creatinine clearance of 53 mVmin before
contrast administration, our findings showed that
changes in renal function were not greater in elderly
952

subjects - without other associated important risk

factors - than in a similar group of younger patients.
Conclusion. In a geriatric population (as in a
younger one) with no known risk factors, diagnostic
examinations can safely be carried out using a
LOCM such as ioversol (Optiray).
The economic implications of the widespread use
of LOCM remain controversial. The cost has to be
weighed against the expected benefits resulting
from an increase in safety.
ACKNOWLEDGEMENT
The authors thank Mrs P. Colnot for typing the manuscript.

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