title: Alprostadil plays a protective role in contrast-induced nephropathy in the elderly.
abstract: OBJECTIVE
  To evaluate the protective effects of alprostadil on contrast-induced nephropathy (CIN) in elderly patients.
  
  
  METHODS
  We randomized 370 patients into the control or alprostadil group. The patients in the control group were injected with 100 ml sterile saline and the patients in the alprostadil group with alprostadil (0.4 μg/kg/day) in 100 ml sterile saline before and after iohexol-enhanced (100 ml) computed tomography (CT). Serum creatinine (Scr), blood urea nitrogen (BUN), cystatin C (CysC), and creatinine clearance (Ccr) were analyzed or calculated. ΔScr and ΔCysC were determined by the changes between baseline and highest Scr and CysC levels. The standard for CIN was a postdose Scr increase >44.2 μmol/l or >25 % over baseline.
  
  
  RESULTS
  In the control group, peak Scr (P < 0.05) and ΔScr (P < 0.01) were higher than those in the alprostadil group. The postdose CysC at 24 h (P < 0.05), 48 h (P < 0.05), and 72 h (P < 0.05), peak CysC (P < 0.01), and ΔCysC (P < 0.05) in the control group were higher than those in the alprostadil group. The incidence of CIN in the control group was 22.2 %, which was higher than in the alprostadil group (9.1 %, P < 0.01). Subgroup analyses in patients with advanced age (≥ 80 years), concomitant hypertension or diabetes, and abnormal baseline renal function (Ccr ≤ 60 ml/min) showed that the alprostadil group had lower ΔScr and ΔCysC than the control group after contrast-enhanced CT examination in all four subgroups (P < 0.05 or P < 0.01).
  
  
  CONCLUSIONS
  In this cohort of older patients undergoing contrast CT, the use of alprostadil reduced the incidence of CIN.
authors.affiliation: Department of Geriatrics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, 600 Yi Shan Road, Shanghai, 200233, China.
authors.forename: Ya
authors.initials: Y
authors.lastname: Miao
authors.forename: Yuan
authors.initials: Y
authors.lastname: Zhong
authors.forename: Hong
authors.initials: H
authors.lastname: Yan
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Bei-Yun
authors.initials: BY
authors.lastname: Wang
authors.forename: Jun
authors.initials: J
authors.lastname: Jin
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000517:prevention & control*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000527:Alprostadil / Q000008:administration & dosage*; D001806:Blood Urea Nitrogen; D003287:Contrast Media / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D007262:Infusions, Intravenous; D007472:Iohexol / Q000009:adverse effects*; D008297:Male; D011322:Primary Prevention / Q000379:methods; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D064804:Urological Agents / Q000008:administration & dosage
chemical_list: D003287:Contrast Media; D055316:Cystatin C; D064804:Urological Agents; D007472:Iohexol; D003404:Creatinine; D000527:Alprostadil