Prevention of Contrast Media-Induced Renal Dysfunction With Prostaglandin E 1 : A Randomized, Double-Blind, Placebo-Controlled Study

Abstract

Preexisting renal impairment is an all-encompassing risk factor for radiocontrast-associated nephrotoxicity. Renal impairment appears to be associated with the inadequate production of renal prostaglandins at the critical time of radiocontrast administration and for a variable time period afterward. We prospectively studied 130 patients with chronic renal insufficiency (serum creatinine > or =1.5 mg/dL) who were undergoing radiocontrast administration. Using a double-blind, randomized, prospective technique, patients were assigned to either placebo or one of three prostaglandin E1 (PGE1) treatment groups (10, 20, or 40 ng/kg/min). Infusion was started 60 +/- 30 minutes before the administration of radiocontrast and was continued for a total of 6 hours. In the placebo group, radiocontrast administration resulted in a mean increase (+/- SD) in serum creatinine of 0.72 +/- 1.15 mg/dL at 48 hours. This increase was less in each of the PGE1 treatment groups after 48 hours, with a significant difference between placebo and the 20 ng/kg/min PGE1 group (P = 0.01). Using baseline adjusted means, analysis of covariance with baseline serum creatinine as the covariable demonstrated significant differences between the placebo and 20 ng/kg/min PGE1 group (P = 0.03) and between the placebo and 10 ng/kg/min PGE1 group P = 0.047). In a subgroup analysis of the diabetic patients, the increase in serum creatinine was less pronounced in the three PGE1 groups versus the placebo group, and the 20 ng/kg/min PGE1 group had the most favorable outcome. The parenteral administration of PGE1 immediately before radiocontrast exposure and continued for a period of 5 to 5.5 hours significantly reduced the elevation of serum creatinine poststudy. The most effective of the three PGE1 dosing regimens was 20 ng/kg/min.

Contrast‐induced nephropathy

“…All the groups treated with prostaglandin E1, independently of given dose, experienced significantly less increase in creatinine after exposure to contrast media compared with placebo. The most pronounced effect was observed in patients that received the intermediate dose of the drug (20 ng/kg/min) [90].…”

“…Based on the decreased levels of prostaglandins in patients with CIN, it was hypothesized that prophylactic administration of prostaglandin E1 may be beneficial in reducing CIN [90]. A double-blind, randomized, placebo-controlled study investigated the effect of intravenous administration of prostaglandin E1 in three various doses.…”

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

“…28 However, only patients receiving the middle dose of alprostadil (20 ng · kg Ϫ1 · min Ϫ1 ) had significantly smaller increases in mean serum creatinine levels than the placebo group.…”

Clinical and Experimental Evidence for Prevention of Acute Renal Failure Induced by Radiographic Contrast Media

“…Moreover, another randomized placebocontrolled study has also shown in 130 patients with renal dysfunction (baseline SCr ³1.5 mg / dL) that infusion of prostaglandin E 1 (10 -40 ng / kg per minute for 6 h) starting from 30 -60 min before RCM injection significantly diminishes the increase in SCr determined at 48 h after radiographic examination, in which the effect is most marked at a dose of 20 ng / kg per minute (95). Therefore, prostaglandin E 1 may be promising as a prophylactic agent against radiocontrast nephropathy.…”