Effect of theophylline on contrast material-nephropathy in patients with chronic renal insufficiency: controlled, randomized, double-blinded study.
OBJECTIVE
To investigate whether the adenosine antagonist theophylline reduces the incidence of contrast material-induced nephropathy (serum creatinine level increase of at least 0.5 mg/dL [44.2 micromol/L] in 48 hours) in high-risk patients who have chronic renal insufficiency and have received at least 100 mL of contrast medium.


METHODS
One hundred patients with serum creatinine levels of 1.3 mg/dL (114.3 micromol/L) or greater were randomly assigned to intravenously receive 200 mg theophylline or saline 30 minutes before administration of 100 mL or more of low-osmolarity contrast medium arterially (72 [72%] patients) or intravenously (28 [28%] patients).


RESULTS
Patients receiving theophylline and control subjects were comparable with regard to risk factors for contrast-induced nephropathy such as mean serum creatinine level before contrast medium administration (2.07 mg/dL +/- 0.94 [SD] [182.9 micromol/L +/- 83.1] vs 1.92 mg/dL +/- 0.76 [169.7 micromol/L +/- 67.2], respectively), amount of contrast medium (196.5 mL +/- 84.1 vs 216.6 mL +/- 95.0, respectively), and diabetes prevalence. Theophylline prophylaxis significantly reduced the incidence of contrast material-induced nephropathy (4% vs 16%; P =.046). With theophylline, the mean serum creatinine level decreased nonsignificantly 12 (1.98 mg/dL +/- 0.77 [175.0 micromol/L +/- 68.1]; P =.09), 24 (1.97 mg/dL +/- 0.75 [174.1 micromol/L +/- 68.1]; P =.99), and 48 (1.94 mg/dL +/- 0.77 [171.5 micromol/L +/- 68.1]; P =.99)(1.94 mg/dL +/- 0.77 [171.5 micromol/L +/- 68.1]; P =.99) hours after contrast medium administration. With a placebo, serum creatinine level significantly increased 24 hours after contrast medium administration (2.01 mg/dL +/- 0.89 [177.7 micromol/L +/- 78.7]; P =.006). Urinary N-acetyl-beta-glucosaminidase level did not change with theophylline administration but significantly (P =.034) increased 24 hours after contrast medium administration with the placebo.


CONCLUSIONS
Prophylactic administration of 200 mg theophylline reduces the incidence of contrast material-induced nephropathy in patients with chronic renal insufficiency.
Huber
Wolfgang
W
II. Medizinische Klinik, Klinische Chemie, Technical University of Munich, Germany. wolfgg.huber@t-online.de
Ilgmann
Kathrin
K
Page
Michael
M
Hennig
Michael
M
Schweigart
Ursula
U
Jeschke
Barbara
B
Lutilsky
Leopoldo
L
Weiss
Wolfgang
W
Salmhofer
Hermann
H
Classen
Meinhard
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced* / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013806:Theophylline / Q000627:therapeutic use*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
D003287:Contrast Media; D014665:Vasodilator Agents; D003404:Creatinine; D013806:Theophylline