Reduced incidence of radiocontrast-induced nephropathy in ICU patients under theophylline prophylaxis: a prospective comparison to series of patients at similar risk.
OBJECTIVE
To investigate whether the adenosine-antagonist theophylline reduces the incidence of contrast-induced nephropathy (CIN).


METHODS
Prospective, comparison to series of patients at similar risk of CIN in a university hospital medical ICU.


METHODS
78 ICU patients with at least one risk factor for CIN undergoing 150 consecutive contrast examinations.


METHODS
Administration of 200 mg theophylline/70 kg BW intravenously 30 min before that of 100 ml or more low-osmolarity contrast medium (CM).


RESULTS
Concentrations of serum creatinine and blood urea nitrogen (BUN), urine volume, fluid balance, and the incidence of CIN [increase in creatinine > or =20.5 mg/dl (= 44.2 micromol/l) within 48 h] were monitored for 48 h. Despite the large number of risk factors (6.8 per patient) including a high dose of CM (169.4 ml), impaired renal function (51%), diabetes (38%), aminoglycosides (61%), vancomycin (53%), catecholamines (52%), creatinine concentrations were not increased 24 h (1.40+/-0.92 mg/dl) or 48 h (1.38+/-0.88 mg/dl) after CM [1.47+/-1.0 mg/dl (= 130+/-88 micromol/l)] vs. baseline. The fluid balance was not different before (+3 ml/h) and after CM (-9 ml/h). The urine volume slightly increased after CM and theophylline (184 ml/h vs. 164 ml/h). Only three patients (2%) developed CIN. The incidence was significantly lower than that of 14% (78/565) in the control series with patients at comparable risk of CIN (p < 0.0001).


CONCLUSIONS
Using a theophylline prophylaxis the incidence of CIN in patients with increased risk of CIN is as low as 2%.
Huber
W
W
Department of Internal Medicine II, Klinikum Rechts der Isar, Technical University Munich, Germany. Wolfgg.Huber@t-online.de
Jeschke
B
B
Page
M
M
Weiss
W
W
Salmhofer
H
H
Schweigart
U
U
Ilgmann
K
K
Reichenberger
J
J
Neu
B
B
Classen
M
M
D000241:Adenosine / Q000037:antagonists & inhibitors*; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D012307:Risk Factors; D013806:Theophylline / Q000627:therapeutic use*; D013997:Time Factors
D003287:Contrast Media; D010726:Phosphodiesterase Inhibitors; D013806:Theophylline; D000241:Adenosine