TY - JOUR
T1 - Iloprost prevents contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention
AU - Spargias, Konstantinos
AU - Adreanides, Elias
AU - Demerouti, Eftihia
AU - Gkouziouta, Angeliki
AU - Manginas, Athanassios
AU - Pavlides, Gregory
AU - Voudris, Vassilis
AU - Cokkinos, Dennis V.
PY - 2009/11
Y1 - 2009/11
N2 - BACKGROUND-: The prevention of contrast-induced nephropathy, which accounts for considerable morbidity and mortality, remains a vexing problem. Contrast-induced renal vasoconstriction is believed to play a pivotal role in the pathogenesis of contrast-induced nephropathy. The aim of this study was to examine the efficacy of the prostacyclin analog iloprost in preventing contrast-induced nephropathy in patients with renal dysfunction undergoing a coronary procedure. METHODS AND RESULTS-: We conducted a randomized, double-blind, placebo-controlled trial of iloprost in 208 patients with a serum creatinine concentration ≥1.4 mg/dL who underwent coronary angiography and/or intervention. Iloprost 1 ng • kg • min or placebo was administered intravenously beginning 30 to 90 minutes before and ending 4 hours after the procedure. Contrast-induced nephropathy was defined by an absolute increase in serum creatinine ≥0.5 mg/dL or a relative increase ≥25% measured 2 to 5 days after the procedure. Contrast-induced nephropathy occurred in 23 of the 105 patients (22%) in the control group and in 8 of the 103 patients (8%) in the iloprost group (odds ratio, 0.29; 95% confidence interval, 0.12 to 0.69; P=0.005). In the control group, the estimated glomerular filtration rate declined from 49.7±15.5 to 46.6±16.6 mL • min • 1.73 m (P=0.01). In the iloprost group, the estimated glomerular filtration rate increased marginally from 47.5±14.5 to 48.6±16.1 mL • min • 1.73 m (P=0.26). The mean absolute estimated glomerular filtration rate decline in the control group was greater than its change in the iloprost group (difference, 4.2 mL • min • 1.73 m; 95% confidence interval, 1.1 to 7.3; P=0.008). CONCLUSION-: Prophylactic administration of iloprost may protect against contrast-induced nephropathy in high-risk patients undergoing a coronary procedure.
AB - BACKGROUND-: The prevention of contrast-induced nephropathy, which accounts for considerable morbidity and mortality, remains a vexing problem. Contrast-induced renal vasoconstriction is believed to play a pivotal role in the pathogenesis of contrast-induced nephropathy. The aim of this study was to examine the efficacy of the prostacyclin analog iloprost in preventing contrast-induced nephropathy in patients with renal dysfunction undergoing a coronary procedure. METHODS AND RESULTS-: We conducted a randomized, double-blind, placebo-controlled trial of iloprost in 208 patients with a serum creatinine concentration ≥1.4 mg/dL who underwent coronary angiography and/or intervention. Iloprost 1 ng • kg • min or placebo was administered intravenously beginning 30 to 90 minutes before and ending 4 hours after the procedure. Contrast-induced nephropathy was defined by an absolute increase in serum creatinine ≥0.5 mg/dL or a relative increase ≥25% measured 2 to 5 days after the procedure. Contrast-induced nephropathy occurred in 23 of the 105 patients (22%) in the control group and in 8 of the 103 patients (8%) in the iloprost group (odds ratio, 0.29; 95% confidence interval, 0.12 to 0.69; P=0.005). In the control group, the estimated glomerular filtration rate declined from 49.7±15.5 to 46.6±16.6 mL • min • 1.73 m (P=0.01). In the iloprost group, the estimated glomerular filtration rate increased marginally from 47.5±14.5 to 48.6±16.1 mL • min • 1.73 m (P=0.26). The mean absolute estimated glomerular filtration rate decline in the control group was greater than its change in the iloprost group (difference, 4.2 mL • min • 1.73 m; 95% confidence interval, 1.1 to 7.3; P=0.008). CONCLUSION-: Prophylactic administration of iloprost may protect against contrast-induced nephropathy in high-risk patients undergoing a coronary procedure.
KW - Angiography
KW - Contrast media
KW - Iloprost
KW - Prostaglandins
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U2 - 10.1161/CIRCULATIONAHA.109.863159
DO - 10.1161/CIRCULATIONAHA.109.863159
M3 - Article
C2 - 19841299
AN - SCOPUS:70449449081
VL - 120
SP - 1793
EP - 1799
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 18
ER -