title: Prophylaxis of contrast material-induced nephropathy in patients in intensive care: acetylcysteine, theophylline, or both? A randomized study.
abstract: 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.
authors.affiliation: II. Medizinische Klinik, Institut für Medizinische Statistik und Epidemiologie, Universitaetsklinik Tuebingen, Kinderkardiologie, Munich, Germany. Wolfgg.Huber@t-online.de
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Huber
authors.forename: Florian
authors.initials: F
authors.lastname: Eckel
authors.forename: Michael
authors.initials: M
authors.lastname: Hennig
authors.forename: Hilkea
authors.initials: H
authors.lastname: Rosenbrock
authors.forename: Annette
authors.initials: A
authors.lastname: Wacker
authors.forename: Dieter
authors.initials: D
authors.lastname: Saur
authors.forename: Angelika
authors.initials: A
authors.lastname: Sennefelder
authors.forename: Romain
authors.initials: R
authors.lastname: Hennico
authors.forename: Cordula
authors.initials: C
authors.lastname: Schenk
authors.forename: Alexander
authors.initials: A
authors.lastname: Meining
authors.forename: Renate
authors.initials: R
authors.lastname: Schmelz
authors.forename: Ralph
authors.initials: R
authors.lastname: Fritsch
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Weiss
authors.forename: Peter
authors.initials: P
authors.lastname: Hamar
authors.forename: Uwe
authors.initials: U
authors.lastname: Heemann
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
mesh_terms: 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
chemical_list: 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