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

Konstantinos Spargias, Elias Adreanides, Eftihia Demerouti, Angeliki Gkouziouta, Athanassios Manginas, Gregory Pavlides, Vassilis Voudris, Dennis V. Cokkinos

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

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 • kg • min 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 ≥0.5 mg/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 • min • 1.73 m (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 • 1.73 m (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 • 1.73 m; 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.

Original languageEnglish (US)
Pages (from-to)1793-1799
Number of pages7
JournalCirculation
Volume120
Issue number18
DOIs
StatePublished - Nov 1 2009

Fingerprint

Iloprost
Coronary Angiography
Kidney
Glomerular Filtration Rate
Control Groups
Creatinine
Placebos
Confidence Intervals
Epoprostenol
Vasoconstriction
Serum
Odds Ratio
Morbidity
Mortality

Keywords

  • Angiography
  • Contrast media
  • Iloprost
  • Prostaglandins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Iloprost prevents contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. / Spargias, Konstantinos; Adreanides, Elias; Demerouti, Eftihia; Gkouziouta, Angeliki; Manginas, Athanassios; Pavlides, Gregory; Voudris, Vassilis; Cokkinos, Dennis V.

In: Circulation, Vol. 120, No. 18, 01.11.2009, p. 1793-1799.

Research output: Contribution to journalArticle

Spargias, K, Adreanides, E, Demerouti, E, Gkouziouta, A, Manginas, A, Pavlides, G, Voudris, V & Cokkinos, DV 2009, 'Iloprost prevents contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention', Circulation, vol. 120, no. 18, pp. 1793-1799. https://doi.org/10.1161/CIRCULATIONAHA.109.863159
Spargias, Konstantinos ; Adreanides, Elias ; Demerouti, Eftihia ; Gkouziouta, Angeliki ; Manginas, Athanassios ; Pavlides, Gregory ; Voudris, Vassilis ; Cokkinos, Dennis V. / Iloprost prevents contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. In: Circulation. 2009 ; Vol. 120, No. 18. pp. 1793-1799.
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AU - Spargias, Konstantinos

AU - Adreanides, Elias

AU - Demerouti, Eftihia

AU - Gkouziouta, Angeliki

AU - Manginas, Athanassios

AU - Pavlides, Gregory

AU - Voudris, Vassilis

AU - Cokkinos, Dennis V.

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N2 - 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 • kg • min 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 ≥0.5 mg/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 • min • 1.73 m (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 • 1.73 m (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 • 1.73 m; 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.

AB - 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 • kg • min 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 ≥0.5 mg/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 • min • 1.73 m (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 • 1.73 m (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 • 1.73 m; 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.

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