Skip to main content

Prophylaxis of contrast-induced nephropathy in patients with impaired renal function: double-blind comparison of acetylcysteine, theophylline, acetylcysteine + theophylline and placebo

Background

Contrast-induced nephropathy (CIN) is frequently found in ICU patients. Several recent studies have shown a prophylactic effect of acetylcysteine (A) and theophylline (T). The results are contradictory, however, and only one study has so far compared the effects of both agents [1]. Nevertheless, this study did not include a placebo group and was not restricted to patients with impaired renal function.

Aim

To compare the effects of A, T, a combination of A and T (A + T) and placebo (P) in patients with impaired renal function.

Materials and methods

Two hundred and fifty-four patients with serum creatinine ≥ 1.3 mg/dl receiving ≥ 100 ml contrast-medium (CM) were randomised to receive A (600 mg, p.o., b.i.d.; start 24 hours before CM), T (200 mg, i.v., 30 min before CM), A + T, or P. Primary endpoint The incidence of CIN (increase of serum creatinine ≥ 0.5 mg/dl within 48 hours). Secondary endpoint Time course of serum-creatinine. Statistics Chi-square-test and Wilcoxon-test, SAS software version 6.12.

Results

Patients of groups A, T, A + T and P were comparable with regard to baseline creatinine (1.49 ± 0.43 vs 1.53 ± 0.56 vs 1.57 ± 0.40 vs 1.69 ± 0.77 mg/dl; not significant [NS]), amount of CM (192.5 ± 104.3 vs 240.2 ± 149.9 vs 222.7 ± 141.9 vs 207.6 ± 113.6 ml; NS) and incidence of other risk factors (RF) such as diabetes and hypertension. The incidence of CIN was 4/62 (6.5%) in group A, 3/64 (4.7%) in group T, 7/66 (10.6%) in group A + T, and 10/62 (16.1%) in group P. Overall, the incidence was lower under prophylaxis (14/192; 7.3%) than under placebo (10/62, 16.1%; P = 0.0386). Patients of group T had a significantly lower incidence of CIN than patients under placebo (P = 0.0348), whereas neither group A nor group A + T had a lower incidence of CIN than group P.

Compared with baseline, serum creatinine levels significantly increased after 48 hours in group A (1.54 ± 0.39 vs 1.49 ± 0.43 mg/dl; P = 0.00986), group A + T (1.63 ± 0.41 vs 1.57 ± 0.40 mg/dl; P = 0.0075) and group P (1.80 ± 0.85 vs 1.69 ± 0.77 mg/dl; P = 0.00619). However, there was no significant increase in group T (1.56 ± 0.55 vs 1.53 ± 0.56 mg/dl; NS).

Conclusions

In patients with impaired renal function theophylline significantly reduces the incidence of CIN, whereas acetylcysteine alone or in combination with theophylline was not effective.

References

  1. 1.

    Intensive Care Med. 2002,28(Suppl 1):S139. 10.1007/s00134-001-1194-1

Download references

Author information

Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Huber, W., Schilling, C., Wacker, A. et al. Prophylaxis of contrast-induced nephropathy in patients with impaired renal function: double-blind comparison of acetylcysteine, theophylline, acetylcysteine + theophylline and placebo. Crit Care 9, P353 (2005). https://doi.org/10.1186/cc3416

Download citation

Keywords

  • Hypertension
  • Placebo
  • Creatinine
  • Placebo Group
  • Serum Creatinine