Effects of an Acute Dose of <i>L-</i>Arginine during Coronary Angiography in Patients with Chronic Renal Failure

Abstract

Background: Contrast media (CM) are nephrotoxic and might further worsen renal function in patients with chronic renal failure. L-Arginine, the substrate of nitric oxide, protects kidney function and may improve endothelial function in patients with coronary artery disease. Hypothesis: Acute administration of L-arginine in a subset of patients with combined coronary artery disease and impaired kidney function during coronary angiography might prevent superimposed acute renal failure. Methods: A double-blind study of patients with mild/moderate chronic renal failure (Cr >1.7 mg/dl) undergoing coronary angiography (meglumine ioxaglate) was conducted. Patients received either L-arginine (300 mg/kg) or placebo and were followed for 48 h. Cardiac hemodynamic parameters, renal function and nitric oxide production were sequentially recorded. Results – Primary and Secondary: Both groups experienced a decrease of creatinine clearance 48 h following the procedure (p < 0.05). Creatinine levels slightly increased following the administration of L-arginine (p < 0.05) but not in the placebo treated group. No changes of systemic and cardiac pressures, total peripheral resistance or cardiac output were recorded within and between the treatment and placebo groups. Conclusion: CM injection causes an impairment of renal function. Addition of intravenous L-arginine during cardiac catheterizations in patients with chronic renal failure does not prevent CM-induced nephrotoxicity and does not affect endothelial dysfunction in the particular population studied by the authors, i.e. patients with coronary artery disease (CAD) of various degrees, or suspicion of CAD and chronic mild renal failure.

Recent Advances in Understanding Endothelial Dysfunction in Atherosclerosis

“…[136][137][138][139] L-arginine supplementation therapy as anti-atherosclerotic approach was supported by numerous studies, 50,[140][141][142][143][144][145] but is recently challenged by increasing the number of other studies showing no such effect or no sustained effect on endothelial function. 50,[145][146][147][148][149] Some studies even showed a harmful effect on atherosclerotic lesion formation 150 in animal models, such as in ApoE -/-/iNOS -/-double knockout mice which are treated chronically with L-arginine supplementation. An increase in production of superoxide anion in atherosclerotic rabbit aortas treated with L-arginine has been recently described.…”

Endothelial arginase: A new target in atherosclerosis

“…Following these early studies, numerous studies with supplemental Larginine therapy have been conducted in animal models and in humans; however, no consistent results can be achieved [24••]. In recent years, there has been an increasing number of studies showing either no effect or no sustained effects on endothelial function by L-arginine supplementation [6,[25][26][27][28][29][30]. Harmful effects on atherosclerotic lesion formation in ApoE/iNOS double-knockout mice have been reported [31].…”

Prevenção de nefrotoxicidade por contraste com solução de bicarbonato: resultados preliminares e revisão da literatura

“…Intravenous hydration with 0.9% SS) 0.9% SS 1 mL/kg/h, 12 hours before and 12 hours after the procedure Several randomized studies and metaanalyses 30,[32][33][34] 0.9% SS is superior to 0.45% SS 23,32 Sodium bicarbonate (154 mEq/L) NaHCO3 3 mL/kg/h, 1 hour before the procedure and 1 mL/kg/h, 6 hours after the procedure Several randomized studies and meta-analyses 32,[49][50][51][52][53][54] Dilute 154 mL of 8.4% sodium bicarbonate in 846 mL of distilled water for obtaining the solution Type of contrast medium Low-osmolality or iso-osmolality contrast medium Some randomized studies and a few meta-analyses [26][27][28] The literature is still controversial whether isoosmolality contrast medium is superior to low-osmolality contrast medium 29 N-acetyl cysteine 600 mg, orally, 12/12 hours, 24 hours before and after the procedure Still controversial 54,55 Large ongoing multicenter study 56 …”

“…[41][42][43][44] Other vasodilating drugs that showed no benefit as compared with placebo in preventing CN were the atrial natriuretic peptide, 45 endothelin antagonists, 46 prostaglandin E 1 , 47 ACE inhibitors 2,48 , and L-arginine. 49 In reality, endothelin antagonists not only did not benefit but also increased the risk of CN for users. 46 Prophylactic hemofiltration has been associated with a reduction in the adverse events related to CN in high risk patients.…”