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

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 ⁻¹ · 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 ≥0.5 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 · 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 · min ⁻¹ · 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 · 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.