Prophylaxis of contrast material-induced nephropathy in patients in intensive care: acetylcysteine, theophylline, or both? A randomized study.
OBJECTIVE
To prospectively compare the protective effect of acetylcysteine, theophylline, and both agents combined in patients who are admitted to the intensive care unit with at least one risk factor for contrast material-induced nephropathy and who receive at least 100 mL of iodinated contrast medium.


METHODS
Institutional ethics review board approval and informed consent were obtained. A total of 91 patients (mean age, 58.5 years+/-14.8 [standard deviation]; 31 women, 60 men; 150 examinations) were admitted to the intensive care unit with at least one risk factor for contrast-induced nephropathy and received either (a) 200 mg theophylline 30 minutes before contrast medium administration (group T), (b) 600 mg acetylcysteine twice daily on the day of and (if possible) the day before the examination (group A), or (c) both agents combined (group AT). The primary endpoint for this study was the incidence of contrast-induced nephropathy (chi2 test).


RESULTS
Groups T, A, and AT were comparable with regard to baseline creatinine levels and the amount of contrast medium administered. The incidence of contrast-induced nephropathy in groups T, A, and AT was 2%, 12%, and 4%, respectively, and was significantly lower in group T than in group A (P=.047). There was no significant difference in the incidence of contrast-induced nephropathy between groups A and AT (P=.148) or between groups T and AT (P=.53). For group A, serum creatinine did not change after 12, 24, or 48 hours compared with baseline. Creatinine levels in group T decreased 12 hours (1.19 mg/dL+/-0.58; P=.008) and 48 hours (1.16 mg/dL+/-0.55; P=.034) after contrast material injection compared with baseline (1.25 mg/dL+/-0.61). In group AT, creatinine significantly decreased 24 hours (1.21 mg/dL+/-0.74; P=.003) and 48 hours (1.17 mg/dL+/-0.69; P<.001) after contrast material injection compared with baseline (1.28 mg/dL+/-0.74). Group A had significantly higher maximal increases in creatinine than groups T and AT (P=.014).


CONCLUSIONS
For prophylaxis of contrast-induced nephropathy in patients who are admitted to the intensive care unit and who receive 100 mL or more of contrast medium, theophylline is superior to acetylcysteine.
Huber
Wolfgang
W
II. Medizinische Klinik, Institut für Medizinische Statistik und Epidemiologie, Universitaetsklinik Tuebingen, Kinderkardiologie, Munich, Germany. Wolfgg.Huber@t-online.de
Eckel
Florian
F
Hennig
Michael
M
Rosenbrock
Hilkea
H
Wacker
Annette
A
Saur
Dieter
D
Sennefelder
Angelika
A
Hennico
Romain
R
Schenk
Cordula
C
Meining
Alexander
A
Schmelz
Renate
R
Fritsch
Ralph
R
Weiss
Wolfgang
W
Hamar
Peter
P
Heemann
Uwe
U
Schmid
Roland M
RM
D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001806:Blood Urea Nitrogen; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D003422:Critical Care; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D016166:Free Radical Scavengers / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007479:Iopamidol / Q000009:adverse effects / Q000031:analogs & derivatives*; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D020011:Protective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D012307:Risk Factors; D013806:Theophylline / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors
D003287:Contrast Media; D004338:Drug Combinations; D016166:Free Radical Scavengers; D010726:Phosphodiesterase Inhibitors; D020011:Protective Agents; C057937:iomeprol; D003404:Creatinine; D013806:Theophylline; D007479:Iopamidol; D000111:Acetylcysteine