Document Type : Original Article(s)
Authors
- Leili Iranirad 1
- Mohammad Saleh Sadeghi 2
- Ahmadreza Bagheri 1
- Kobra Doostali 1
- Samieh Norouzi 1
- Seyed Fakhreddin Hejazi 1
- Hossein Saghafi 3
- Sakineh Roshani-Mobaraki 4
1 Assistant Professor, Department of Cardiology, School of Medicine, Qom University of Medical Sciences, Qom, Iran
2 Student Research Committee, School of Medicine, Qom University of Medical Sciences, Qom, Iran
3 Associate Professor, Department of Internal Medicine, School of Medicine, Qom University of Medical Sciences, Qom, Iran
4 Nursing Research Center AND School of Medicine, Qom University of Medical Sciences, Qom, Iran
Abstract
BACKGROUND: Contrast-induced nephropathy (CIN) is considered to be a possibly severe complication of radiography and thus, remains to be the main cause of acute kidney injury (AKI) for inpatients. A clinical trial was executed to measure the preventive effect of allopurinol against CIN in high-risk patients undertaking coronary angiography. METHODS: Through randomized controlled trial, 140 patients with at minimum two risk factors of CIN, undertaking coronary angiography, were randomly allocated to the allopurinol (n = 70) or control group (n = 70). Those in the allopurinol group received allopurinol (300 mg) a day before their coronary angiography and intravenous hydration for 12 hours before and after their procedure, while members of the control group only received intravenous hydration. Serum creatinine (SCr), blood urea nitrogen (BUN) and uric acid were measured before and 48 hours after the procedure. CIN was defined by a 25% increase in SCr or the concentration of > 0.5 mg/dl, 48 hours after coronary angiography. RESULTS: CIN was observed in 8 (11.4%) patients in the allopurinol group and 11 (15.7%) patients in the control group. There was no significant difference in the incidence of CIN between the two groups at 48 hours after coronary angiography (P = 0.459). In the allopurinol group, the median SCr concentration decreased non-significantly from 1.16 mg/dl to 1.13 mg/dl, 48 hours after coronary angiography (P = 0.189). In the control group, the median SCr concentration increased significantly from 1.11 mg/dl to 1.2 mg/dl, 48 hours after coronary angiography (P < 0.001). CONCLUSION: Allopurinol presents no considerable effectiveness over the hydration protocol for development of CIN in high-risk patients.
Keywords
- Thayssen P, Lassen JF, Jensen SE, Hansen KN, Hansen HS, Christiansen EH, et al. Prevention of contrast-induced nephropathy with N-acetylcysteine or sodium bicarbonate in patients with ST-segment-myocardial infarction: A prospective, randomized, open-labeled trial. Circ Cardiovasc Interv 2014; 7(2): 216-24.
- Cheungpasitporn W, Thongprayoon C, Brabec BA, Edmonds PJ, O'Corragain OA, Erickson SB. Oral hydration for prevention of contrast-induced acute kidney injury in elective radiological procedures: A systematic review and meta-analysis of randomized controlled trials. N Am J Med Sci 2014; 6(12): 618-24.
- Wu MY, Hsiang HF, Wong CS, Yao MS, Li YW, Hsiang CY, et al. The effectiveness of N-Acetylcysteine in preventing contrast-induced nephropathy in patients undergoing contrast-enhanced computed tomography: A meta-analysis of randomized controlled trials. Int Urol Nephrol 2013; 45(5): 1309-18.
- Chyou AC, Thodge A, Feldman DN, Swaminathan RV. Statins in the prevention of contrast-induced nephropathy. Curr Treat Options Cardiovasc Med 2015; 17(4): 375.
- Wong PC, Li Z, Guo J, Zhang A. Pathophysiology of contrast-induced nephropathy. Int J Cardiol 2012; 158(2): 186-92.
- Wu Z, Zhang H, Jin W, Liu Y, Lu L, Chen Q, et al. The effect of renin-angiotensin-aldosterone system blockade medications on contrast-induced nephropathy in patients undergoing coronary angiography: A meta-analysis. PLoS One 2015; 10(6): e0129747.
- Mehran R, Aymong ED, Nikolsky E, Lasic Z, Iakovou I, Fahy M, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation. J Am Coll Cardiol 2004; 44(7): 1393-9.
- Wessely R, Koppara T, Bradaric C, Vorpahl M, Braun S, Schulz S, et al. Choice of contrast medium in patients with impaired renal function undergoing percutaneous coronary intervention. Circ Cardiovasc Interv 2009; 2(5): 430-7.
- Kassis HM, Minsinger KD, McCullough PA, Block CA, Sidhu MS, Brown JR. A review of the use of iloprost, a synthetic prostacyclin, in the prevention of radiocontrast nephropathy in patients undergoing coronary angiography and intervention. Clin Cardiol 2015; 38(8): 492-8.
- Erol T, Tekin A, Katircibasi MT, Sezgin N, Bilgi M, Tekin G, et al. Efficacy of allopurinol pretreatment for prevention of contrast-induced nephropathy: A randomized controlled trial. Int J Cardiol 2013; 167(4): 1396-9.
- Gomes VO, Poli de Figueredo CE, Caramori P, Lasevitch R, Bodanese LC, Araujo A, et al. N-acetylcysteine does not prevent contrast induced nephropathy after cardiac catheterisation with an ionic low osmolality contrast medium: A multicentre clinical trial. Heart 2005; 91(6): 774-8.
- Iranirad L, Hejazi SF, Sadeghi MS, Jang SA. Efficacy of nicorandil treatment for prevention of contrast-induced nephropathy in high-risk patients undergoing cardiac catheterization: A prospective randomized controlled trial. Cardiol J 2017.
- Arabmomeni M, Najafian J, Abdar EM, Samadi M, Mirbagher L. Comparison between theophylline, N-acetylcysteine, and theophylline plus N-acetylcysteine for the prevention of contrast-induced nephropathy. ARYA Atheroscler 2015; 11(1): 43-9.
- Sanei H, Hajian-Nejad A, Sajjadieh-Kajouei A, Nazemzadeh N, Alizadeh N, Bidram P, et al. Short term high dose atorvastatin for the prevention of contrast-induced nephropathy in patients undergoing computed tomography angiography. ARYA Atheroscler 2014; 10(5): 252-8.
- O'Sullivan S, Healy DA, Moloney MC, Grace PA, Walsh SR. The role of N-acetylcysteine in the prevention of contrast-induced nephropathy in patients undergoing peripheral angiography: A structured review and meta-analysis. Angiology 2013; 64(8): 576-82.
- Khaledifar A, Momeni A, Ebrahimi A, Kheiri S, Mokhtari A. Comparison of N-acetylcysteine, ascorbic acid, and normal saline effect in prevention of contrast-induced nephropathy. ARYA Atheroscler 2015; 11(4): 228-32.
- Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18(12): 1440-63.
- Kumar A, Bhawani G, Kumari N, Murthy KS, Lalwani V, Raju C. Comparative study of renal protective effects of allopurinol and N-acetyl-cysteine on contrast induced nephropathy in patients undergoing cardiac catheterization. J Clin Diagn Res 2014; 8(12): HC03-HC07.
- Gu G, Zhang Y, Lu R, Cui W. Additional furosemide treatment beyond saline hydration for the prevention of contrast-induced nephropathy: A meta-analysis of randomized controlled trials. Int J Clin Exp Med 2015; 8(1): 387-94.
- Xing Y, Wei RB, Tang L, Yang Y, Zheng XY, Wang ZC, et al. Protective effect of salidroside on contrast-induced nephropathy in comparison with N-acetylcysteine and its underlying mechanism. Chin J Integr Med 2015; 21(4): 266-73.
- Tumlin J, Stacul F, Adam A, Becker CR, Davidson C, Lameire N, et al. Pathophysiology of contrast-induced nephropathy. Am J Cardiol 2006; 98(6A): 14K-20K.
)