Iloprost for prevention of contrast-mediated nephropathy in high-risk patients undergoing a coronary procedure. Results of a randomized pilot study

K. Spargias, E. Adreanides, G. Giamouzis, S. Karagiannis, A. Gouziouta, A. Manginas, V. Voudris, G. Pavlides, D. V. Cokkinos

Research output: Contribution to journalArticle

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Abstract

Objective: The prevention of contrast-mediated nephropathy (CMN), which accounts for considerable morbidity and mortality, remains a vexing problem. Contrast induced renal vasoconstriction is believed to play a pivotal role in the CMN mechanism. The aim of this pilot study was to examine the safety and efficacy of two doses of the prostacyclin analogue iloprost in preventing CMN in high-risk patients undergoing a coronary procedure. Methods: Forty-five patients undergoing coronary angiography and/or intervention who had a serum creatinine concentration ≥1.4 mg/dL were randomized to receive iloprost at 1 or 2 ng/kg/min or placebo, beginning 30-90 minutes before and terminating 4 hours after the procedure. CMN was defined by an absolute increase of serum creatinine ≥0.5 mg/dL or a relative increase of ≥25% measured 2 to 5 days after the procedure. Study drug infusion was discontinued in 2 patients in the low-dose iloprost group due to flush/nausea and in 5 patients in the high-dose group due to severe hypotension. Results: The mean creatinine concentration change in the placebo group (0.02 mg/dL) was unfavorable compared to that in the low-dose iloprost group (-0.11 mg/dL; p=0.08) and high-dose iloprost group (-0.23 mg/dL; p=0.048). The difference between the absolute changes in creatinine clearance was favorable compared to placebo for both the low (mean difference 6.1 mL/min, 95%CI -0.5 to 12.8 mL/min, p=0.07) and the high-dose iloprost group (11.8 mL/min, 95%CI 4.7 to 18.8 mL/min, p=0.002). Three cases of CMN were recorded; all in the placebo group (p=0.032). Conclusions: The results of this pilot study suggest that prophylactic administration of iloprost may effectively prevent CMN, but higher dosages are connected with substantial tolerability issues.

Original languageEnglish (US)
Pages (from-to)589-595
Number of pages7
JournalEuropean Journal of Clinical Pharmacology
Volume62
Issue number8
DOIs
StatePublished - Aug 1 2006

Fingerprint

Iloprost
Creatinine
Placebos
Epoprostenol
Vasoconstriction
Coronary Angiography
Serum
Hypotension
Nausea
Morbidity
Kidney
Safety
Mortality

Keywords

  • Contrast nephropathy
  • Coronary angiogrphy
  • Iloprost
  • Prostacyclin
  • Prostaglandins

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Iloprost for prevention of contrast-mediated nephropathy in high-risk patients undergoing a coronary procedure. Results of a randomized pilot study. / Spargias, K.; Adreanides, E.; Giamouzis, G.; Karagiannis, S.; Gouziouta, A.; Manginas, A.; Voudris, V.; Pavlides, G.; Cokkinos, D. V.

In: European Journal of Clinical Pharmacology, Vol. 62, No. 8, 01.08.2006, p. 589-595.

Research output: Contribution to journalArticle

Spargias, K. ; Adreanides, E. ; Giamouzis, G. ; Karagiannis, S. ; Gouziouta, A. ; Manginas, A. ; Voudris, V. ; Pavlides, G. ; Cokkinos, D. V. / Iloprost for prevention of contrast-mediated nephropathy in high-risk patients undergoing a coronary procedure. Results of a randomized pilot study. In: European Journal of Clinical Pharmacology. 2006 ; Vol. 62, No. 8. pp. 589-595.
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abstract = "Objective: The prevention of contrast-mediated nephropathy (CMN), which accounts for considerable morbidity and mortality, remains a vexing problem. Contrast induced renal vasoconstriction is believed to play a pivotal role in the CMN mechanism. The aim of this pilot study was to examine the safety and efficacy of two doses of the prostacyclin analogue iloprost in preventing CMN in high-risk patients undergoing a coronary procedure. Methods: Forty-five patients undergoing coronary angiography and/or intervention who had a serum creatinine concentration ≥1.4 mg/dL were randomized to receive iloprost at 1 or 2 ng/kg/min or placebo, beginning 30-90 minutes before and terminating 4 hours after the procedure. CMN was defined by an absolute increase of serum creatinine ≥0.5 mg/dL or a relative increase of ≥25{\%} measured 2 to 5 days after the procedure. Study drug infusion was discontinued in 2 patients in the low-dose iloprost group due to flush/nausea and in 5 patients in the high-dose group due to severe hypotension. Results: The mean creatinine concentration change in the placebo group (0.02 mg/dL) was unfavorable compared to that in the low-dose iloprost group (-0.11 mg/dL; p=0.08) and high-dose iloprost group (-0.23 mg/dL; p=0.048). The difference between the absolute changes in creatinine clearance was favorable compared to placebo for both the low (mean difference 6.1 mL/min, 95{\%}CI -0.5 to 12.8 mL/min, p=0.07) and the high-dose iloprost group (11.8 mL/min, 95{\%}CI 4.7 to 18.8 mL/min, p=0.002). Three cases of CMN were recorded; all in the placebo group (p=0.032). Conclusions: The results of this pilot study suggest that prophylactic administration of iloprost may effectively prevent CMN, but higher dosages are connected with substantial tolerability issues.",
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author = "K. Spargias and E. Adreanides and G. Giamouzis and S. Karagiannis and A. Gouziouta and A. Manginas and V. Voudris and G. Pavlides and Cokkinos, {D. V.}",
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T1 - Iloprost for prevention of contrast-mediated nephropathy in high-risk patients undergoing a coronary procedure. Results of a randomized pilot study

AU - Spargias, K.

AU - Adreanides, E.

AU - Giamouzis, G.

AU - Karagiannis, S.

AU - Gouziouta, A.

AU - Manginas, A.

AU - Voudris, V.

AU - Pavlides, G.

AU - Cokkinos, D. V.

PY - 2006/8/1

Y1 - 2006/8/1

N2 - Objective: The prevention of contrast-mediated nephropathy (CMN), which accounts for considerable morbidity and mortality, remains a vexing problem. Contrast induced renal vasoconstriction is believed to play a pivotal role in the CMN mechanism. The aim of this pilot study was to examine the safety and efficacy of two doses of the prostacyclin analogue iloprost in preventing CMN in high-risk patients undergoing a coronary procedure. Methods: Forty-five patients undergoing coronary angiography and/or intervention who had a serum creatinine concentration ≥1.4 mg/dL were randomized to receive iloprost at 1 or 2 ng/kg/min or placebo, beginning 30-90 minutes before and terminating 4 hours after the procedure. CMN was defined by an absolute increase of serum creatinine ≥0.5 mg/dL or a relative increase of ≥25% measured 2 to 5 days after the procedure. Study drug infusion was discontinued in 2 patients in the low-dose iloprost group due to flush/nausea and in 5 patients in the high-dose group due to severe hypotension. Results: The mean creatinine concentration change in the placebo group (0.02 mg/dL) was unfavorable compared to that in the low-dose iloprost group (-0.11 mg/dL; p=0.08) and high-dose iloprost group (-0.23 mg/dL; p=0.048). The difference between the absolute changes in creatinine clearance was favorable compared to placebo for both the low (mean difference 6.1 mL/min, 95%CI -0.5 to 12.8 mL/min, p=0.07) and the high-dose iloprost group (11.8 mL/min, 95%CI 4.7 to 18.8 mL/min, p=0.002). Three cases of CMN were recorded; all in the placebo group (p=0.032). Conclusions: The results of this pilot study suggest that prophylactic administration of iloprost may effectively prevent CMN, but higher dosages are connected with substantial tolerability issues.

AB - Objective: The prevention of contrast-mediated nephropathy (CMN), which accounts for considerable morbidity and mortality, remains a vexing problem. Contrast induced renal vasoconstriction is believed to play a pivotal role in the CMN mechanism. The aim of this pilot study was to examine the safety and efficacy of two doses of the prostacyclin analogue iloprost in preventing CMN in high-risk patients undergoing a coronary procedure. Methods: Forty-five patients undergoing coronary angiography and/or intervention who had a serum creatinine concentration ≥1.4 mg/dL were randomized to receive iloprost at 1 or 2 ng/kg/min or placebo, beginning 30-90 minutes before and terminating 4 hours after the procedure. CMN was defined by an absolute increase of serum creatinine ≥0.5 mg/dL or a relative increase of ≥25% measured 2 to 5 days after the procedure. Study drug infusion was discontinued in 2 patients in the low-dose iloprost group due to flush/nausea and in 5 patients in the high-dose group due to severe hypotension. Results: The mean creatinine concentration change in the placebo group (0.02 mg/dL) was unfavorable compared to that in the low-dose iloprost group (-0.11 mg/dL; p=0.08) and high-dose iloprost group (-0.23 mg/dL; p=0.048). The difference between the absolute changes in creatinine clearance was favorable compared to placebo for both the low (mean difference 6.1 mL/min, 95%CI -0.5 to 12.8 mL/min, p=0.07) and the high-dose iloprost group (11.8 mL/min, 95%CI 4.7 to 18.8 mL/min, p=0.002). Three cases of CMN were recorded; all in the placebo group (p=0.032). Conclusions: The results of this pilot study suggest that prophylactic administration of iloprost may effectively prevent CMN, but higher dosages are connected with substantial tolerability issues.

KW - Contrast nephropathy

KW - Coronary angiogrphy

KW - Iloprost

KW - Prostacyclin

KW - Prostaglandins

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