Iloprost Prevents Contrast-Induced Nephropathy in Patients With Renal Dysfunction Undergoing Coronary Angiography or Intervention

Article

关键词: HIGH-RISK PATIENTS;    PROSTACYCLIN ANALOG;    SODIUM-BICARBONATE;    RADIOCONTRAST NEPHROPATHY;    MEDIATED NEPHROPATHY;    CARDIAC ANGIOGRAPHY;    IMPAIRED PATIENTS;    N-ACETYLCYSTEINE;    NITRIC-OXIDE;    INSUFFICIENCY;   

DOI  :  10.1161/CIRCULATIONAHA.109.863159

来源: SCIE

【 摘 要 】

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. Methods and Results-We conducted a randomized, double-blind, placebo- controlled trial of iloprost in 208 patients with a serum creatinine concentration >= 1.4 mg/dL who underwent coronary angiography and/or intervention. Iloprost 1 ng center dot kg(-1 center dot)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 >= 0.5mg/dL or a relative increase >= 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 center dot min(-1) center dot 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 center dot min(-1) center dot 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 center dot min(-1) +/- 1.73 m(-2-), 95% confidence interval, 1.1 to 7.3; P=0.008). Conclusion-Prophylactic administration of iloprost may protect against contrast-induced nephropathy in high-risk patients undergoing a coronary procedure. (Circulation. 2009;120:1793-1799.)

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