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Effectiveness of theophylline in preventing contrast-induced nephropathy after coronary angiographic procedures
Mohammed Elshawadfy M Bilasy1, Mohammed A Oraby, Hussein M Ismail
1Department of Cardiovascular Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Insights
Theophylline effectively prevents contrast-induced nephropathy (CIN) in patients undergoing coronary angiography. Adding theophylline to IV hydration and N-acetylcysteine (NAC) significantly reduces the risk of CIN.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Contrast-induced nephropathy (CIN) is a significant cause of hospital-acquired acute renal failure.
- Theophylline's role in CIN prevention has shown conflicting results.
- This study investigates theophylline's efficacy in preventing CIN when combined with IV hydration and N-acetylcysteine (NAC).
Purpose of the Study:
- To evaluate the effectiveness of theophylline in preventing contrast-induced nephropathy (CIN).
- To assess the additive protective effect of theophylline when used with intravenous hydration and N-acetylcysteine (NAC).
Main Methods:
- A single-blind, randomized controlled trial involving 60 patients at moderate-to-high risk for CIN.
- All patients received IV hydration and NAC; theophylline or placebo was administered before contrast medium (CM).
- Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) were measured before and 72 hours after CM administration.
Main Results:
- None of the patients receiving theophylline developed CIN, compared to 20% in the placebo group.
- Theophylline significantly decreased SCr (P = 0.0001) and increased eGFR (P = 0.001) at 72 hours post-CM.
- Independent predictors of renal function deterioration included receiving placebo, anemia, congestive heart failure, chronic renal impairment, and high-contrast load.
Conclusions:
- Theophylline demonstrates effectiveness as prophylaxis against CIN in moderate- and high-risk patients undergoing coronary procedures.
- Theophylline provides additive protection against CIN when administered with IV hydration and NAC.
- Theophylline is a promising agent for preventing CIN in at-risk patient populations.
Background:
Contrast-induced nephropathy (CIN) is the third most common cause of hospital acquired acute renal failure and is associated with increased morbidity and mortality. The use of theophylline for prevention of CIN has yielded conflicting results. This study aimed at examining the effectiveness of theophylline in prevention of CIN when added to IV hydration and N-acetylcysteine (NAC).
Methods:
Patients with stable serum creatinine and at least moderate risk for CIN according to Mehran's risk score were included in this parallel group, 1:1, single-blind, randomized controlled trial. All patients received IV hydration (1 mL/kg per hour for 24 hours) and NAC (600 mg bid for 2 days). Patients were randomized to placebo (group P) or theophylline (200 mg in 100 mL 0.9% saline, as IV infusion 30 minutes before contrast medium (CM) administration; group T). Patients underwent standard coronary angiography ± angioplasty. Serum creatinine (SCr) was assessed just before and 72 hours after contrast administration and estimated glomerular filtration rate (eGFR) was calculated.
Results:
This study included 60 patients with mean SCr 1.44 ± 0.7 mg/dL and eGFR 60.2 ± 29.2 mL/min. Mean SCr among group T was 1.54 ± 0.7 mg/dL with eGFR 58.6 ± 28.6 mL/min, while group P showed mean SCr of 1.34 ± 0.7 mg/dL and eGFR of 61.8 ± 30.1 mL/min. Among group P, 6 (20%) patients developed CIN while none of the patients in group T developed CIN. In comparison to placebo, theophylline significantly decreased SCr (P = 0.0001) and increased eGFR (P = 0.001) at 72 hours. Multivariate regression analysis showed that receiving placebo instead of theophylline, anemia, congestive heart failure, chronic renal impairment, and high-contrast load are all independent predictors for deteriorating renal function after CM administration.
Conclusion:
Theophylline seems to be an effective prophylaxis against CIN for moderate- and high-risk patients undergoing coronary angiography or angioplasty. It offers additive protection when added to IV hydration and NAC.
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