Although the optimal strategy for preventing contrast-induced acute kidney injury (CI-AKI) has not yet been established, the current strategy focuses on adequate periprocedural hydration, the use of a low amount of low or iso-osmolar contrast medium, and the application of adjunctive therapies, including hemofiltration, hemodialysis and drugs. Previous trials and meta-analyses concerning the use of the adenosine antagonist theophylline have revealed contradictory results. We sought to evaluate the effect of theophylline in CI-AKI prevention in well-hydrated elderly patients with chronic kidney disease. We therefore conducted a randomized, double-blind, placebo-controlled trial involving 56 patients who had been referred for cardiac coronary angiography and/or angioplasty. 31 of these patients were randomly assigned to 200 mg theophylline IV before the procedure, and 25 to a placebo. The iso-osmolar contrast medium iodixanol was used. The primary endpoint was an increase in serum creatinine at study termination 48 h after contrast medium administration. Baseline characteristics in the placebo and theophylline groups were similar in terms of median age (75 years), estimated glomerular filtration rate (33 ± 10 vs. 33 ± 10 ml/min/1.73 m²; p = 0.87), diabetes mellitus (80 vs. 71%; p = 0.54), and amount of contrast used (94 ± 35 vs. 95 ± 38 ml; p = 0.89). There was no difference in serum creatinine at baseline (2.06 ± 0.59 vs. 2.02 ± 0.45 mg/dl; p = 0.62) or study termination (2.06 ± 0.68 vs. 2.10 ± 0.53; p = 0.79). A prophylactic effect of theophylline was not observed. The incidence of renal impairment following exposure to the contrast medium was low. This fact can be attributed to adequate parenteral hydratation and the use of the minimum amount of contrast medium necessary.
- MeSH
- Acute Kidney Injury blood etiology physiopathology prevention & control MeSH
- Angioplasty, Balloon, Coronary MeSH
- Biomarkers blood MeSH
- Time Factors MeSH
- Chronic Disease MeSH
- Double-Blind Method MeSH
- Glomerular Filtration Rate drug effects MeSH
- Infusions, Intravenous MeSH
- Contrast Media adverse effects diagnostic use MeSH
- Coronary Angiography MeSH
- Creatinine blood MeSH
- Triiodobenzoic Acids adverse effects diagnostic use MeSH
- Kidney drug effects metabolism physiopathology MeSH
- Humans MeSH
- Kidney Diseases blood complications physiopathology MeSH
- Heart Diseases complications radiography therapy MeSH
- Placebo Effect MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Theophylline administration & dosage MeSH
- Age Factors MeSH
- Water-Electrolyte Balance MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
- Geographicals
- Czech Republic MeSH
Cíl. Určení dlouhodobějšího efektu jódové kontrastní látky na zbytkovou diurézu a reziduální renální funkce hemodialyzovaných nemocných. Metoda. Do prospektivní studie byli zařazeni 42 hemodialyzovaní pacienti s významnou zbytkovou diurézou (alespoň 500 ml moči/den), kterým byla intravaskulárně podána izoosmolární jódová kontrastní látka iodixanol (Visipaque, GE Healthcare) s koncentrací jódu 320 mg/ml a osmolalitou 290 m Osm/kg vody. Průměrně bylo podáno 99,3 ml iodixanolu (v rozmezí 60-180 ml). Tito pacienti byli porovnáni s kontrolním souborem 45 pacientů, kterým nebyla jódová kontrastní látka podána. Sledovanými parametry byly zbytková diuréza a clearance kreatininu v obou skupinách po dobu 6 měsíců. Výsledky. Při statistickém porovnání průměrných poklesů objemu moči a clearance kreatininu mezi skupinami nebyl nalezen statisticky významný rozdíl: pro objem p = 0,855 pro clearanci p = 0,573. Závěr. Zbytková diuréza je ovlivněna podáním isotonické neiontové kontrastní látky iodixanolu v množství 60-180 ml jen nevýznamně oproti přirozenému poklesu reziduálních renálních funkcí při spontánním průběhu onemocnění.
Aim. To evaluate impact of intravascular iodinated contrast medium on residual renal function in hemodialysed patiens. Method. Two groups of hemodialysed patiens with clinically signifcant residual renal function (minimally 500 ml of urine per day) were studied. The patients from the first group were given isoosmolal contrast agent iodixanol (Visipaque GE Healthcare, United Kingdom) in concentration of iodine 320 mg/ml with osmolality 290 mOsm/kg of water during endovascular procedure. The second control group was followed without contrast medium administered. The evaluated group included 42 patients whom were given 99.3 ml of iodixanol in average (range from 60 to 180 ml). The control group included 45 patients. Residual diuresis and clearance of creatinine had been evaluated in the both groups following 6 months. Results. Tere was no statistically signifcant diference found between both groups in daily volume of urine (p = 0.855) and clearance of creatinine (p = 0.573). Conclusion. Residual diuresis is not signifcantly infuenced by intravascular administration of isotonic iodinated contrast agent (iodixanol) in range of volume from 60 to 180 ml in comparison to natural decrease of residual renal functions.
- MeSH
- Kidney Failure, Chronic diagnosis urine MeSH
- Renal Dialysis utilization MeSH
- Diuresis drug effects MeSH
- Iodine diagnostic use adverse effects MeSH
- Contrast Media poisoning MeSH
- Triiodobenzoic Acids diagnostic use urine adverse effects MeSH
- Humans MeSH
- Prospective Studies MeSH
- Statistics as Topic methods MeSH
- Kidney Function Tests methods statistics & numerical data utilization MeSH
- Check Tag
- Humans MeSH
