title: Safety of regadenoson as a pharmacologic stress agent for myocardial perfusion imaging in chronic kidney disease patients not on hemodialysis.
abstract: BACKGROUND
  Pharmacokinetic studies suggest delayed clearance of Regadenoson (REG), a new selective A2A receptor agonist in chronic kidney disease (CKD). The safety of REG in large series of CKD patients in daily clinical practice remains unstudied.
  
  
  METHODS
  Retrospective study of patients with eGFR < 60 mL/min (n = 411, Grp 1, CKD) were compared to patients with eGFR ≥ 60 mL/min (n = 638, Grp 2, Control) undergoing REG-SPECT from Jan to Nov 2009. Patient demographics, REG-SPECT data, side effects, and arrhythmia occurrences were evaluated.
  
  
  RESULTS
  No major adverse events were noted immediately after REG-SPECT or at 1 week of follow-up. There were no differences in any arrhythmias in between the two groups (Grp 1, 47.2% vs Grp 2, 42.9%, P = ns). Ninety-nine percent of arrhythmias in CKD patients were PACs or PVCs. Transient junctional rhythm was observed in one CKD patient. There were no occurrences of second degree or higher degree AV block. Grp 1 had a blunted heart rate response (16.6 ± 16.1 vs 24.9 ± 20.3 bpm, P ≤ .001) and greater systolic blood pressure drop response (-7.4 ± 21.1 vs -1.4 ± 20.9 mm Hg, P ≤ .001) compared to Grp 2. Transient headache was more in Grp 2 (15.8% vs 22.6%, P ≤ .007). Aminophylline use to ward-off the side effects was comparable (9.5% vs 9.9%, P = ns).
  
  
  CONCLUSIONS
  REG-SPECT can be safely performed in CKD non-dialysis patients with excellent tolerability, minimal side effects, and favorable hemodynamic responses compared to control group.
authors.affiliation: Department of Internal Medicine, McLaren Regional Medical Center/Michigan State University, Flint, MI 48202, USA. gurunanthanp@gmail.com
authors.forename: Gurunanthan
authors.initials: G
authors.lastname: Palani
authors.forename: Zehra
authors.initials: Z
authors.lastname: Husain
authors.forename: Rafael Cabrera
authors.initials: RC
authors.lastname: Salinas
authors.forename: Vanji
authors.initials: V
authors.lastname: Karthikeyan
authors.forename: Aarthee S
authors.initials: AS
authors.lastname: Karthikeyan
authors.forename: Karthik
authors.initials: K
authors.lastname: Ananthasubramaniam
mesh_terms: D058908:Adenosine A2 Receptor Agonists / Q000009:adverse effects*; D000368:Aged; D002908:Chronic Disease; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000009:adverse effects*; D011687:Purines / Q000009:adverse effects*; D011720:Pyrazoles / Q000009:adverse effects*; D006435:Renal Dialysis; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000009:adverse effects*
chemical_list: D058908:Adenosine A2 Receptor Agonists; D011687:Purines; D011720:Pyrazoles; C430916:regadenoson