Iloprost prevents contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention.
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.


RESULTS
We conducted a randomized, double-blind, placebo-controlled trial of iloprost in 208 patients with a serum creatinine concentration >or=1.4 mg/dL who underwent coronary angiography and/or intervention. Iloprost 1 ng kg(-1) min(-1) 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 >or=0.5 mg/dL or a relative increase >or=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) 1.73 m(-2) (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) 1.73 m(-2) (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) 1.73 m(-2); 95% confidence interval, 1.1 to 7.3; P=0.008).


CONCLUSIONS
Prophylactic administration of iloprost may protect against contrast-induced nephropathy in high-risk patients undergoing a coronary procedure.
Spargias
Konstantinos
K
Department of Cardiology, Onassis Cardiac Surgery Centre, Athens, Greece. spargias@ocsc.gr
Adreanides
Elias
E
Demerouti
Eftihia
E
Gkouziouta
Angeliki
A
Manginas
Athanassios
A
Pavlides
Gregory
G
Voudris
Vassilis
V
Cokkinos
Dennis V
DV
D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016285:Iloprost / Q000627:therapeutic use*; D007674:Kidney Diseases; D008297:Male; D008875:Middle Aged; D009393:Nephritis / Q000139:chemically induced / Q000517:prevention & control*; D011292:Premedication / Q000379:methods; D020011:Protective Agents; D016896:Treatment Outcome; D014665:Vasodilator Agents
D003287:Contrast Media; D020011:Protective Agents; D014665:Vasodilator Agents; D016285:Iloprost