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Genitourinary Imaging |
,
Barbara Jeschke, MD,
Leopoldo Lutilsky, MD,
Wolfgang Weiss, MD,
Hermann Salmhofer, MD and
Meinhard Classen, MD
1 From the II. Medizinische Klinik, Klinische Chemie (W.H., K.I., M.P., U.S., B.J., H.S., M.C.); Institut für Medizinische Statistik und Epidemiologie (M.H.), I. Medizinische Klinik (L.L.), and Department of Radiology (W.W.), Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, Station 2/11, D-81675 Munich, Germany. Received March 17, 2001; revision requested April 30; final revision received November 7; accepted December 6. Address correspondence to W.H. (e-mail: wolfgg.huber@t-online.de).
2 Dr Schweigart died in April 2000.
PURPOSE: To investigate whether the adenosine antagonist theophylline reduces the incidence of contrast material–induced nephropathy (serum creatinine level increase of at least 0.5 mg/dL [44.2 µmol/L] in 48 hours) in high-risk patients who have chronic renal insufficiency and have received at least 100 mL of contrast medium.
MATERIALS AND METHODS: One hundred patients with serum creatinine levels of 1.3 mg/dL (114.3 µmol/L) or greater were randomly assigned to intravenously receive 200 mg theophylline or saline 30 minutes before administration of 100 mL or more of low-osmolarity contrast medium arterially (72 [72%] patients) or intravenously (28 [28%] patients).
RESULTS: Patients receiving theophylline and control subjects were comparable with regard to risk factors for contrast-induced nephropathy such as mean serum creatinine level before contrast medium administration (2.07 mg/dL ± 0.94 [SD] [182.9 µmol/L ± 83.1] vs 1.92 mg/dL ± 0.76 [169.7 µmol/L ± 67.2], respectively), amount of contrast medium (196.5 mL ± 84.1 vs 216.6 mL ± 95.0, respectively), and diabetes prevalence. Theophylline prophylaxis significantly reduced the incidence of contrast material–induced nephropathy (4% vs 16%; P = .046). With theophylline, the mean serum creatinine level decreased nonsignificantly 12 (1.98 mg/dL ± 0.77 [175.0 µmol/L ± 68.1]; P = .09), 24 (1.97 mg/dL ± 0.75 [174.1 µmol/L ± 68.1]; P = .99), and 48 (1.94 mg/dL ± 0.77 [171.5 µmol/L ± 68.1]; P = .99)(1.94 mg/dL ± 0.77 [171.5 µmol/L ± 68.1]; P = .99) hours after contrast medium administration. With a placebo, serum creatinine level significantly increased 24 hours after contrast medium administration (2.01 mg/dL ± 0.89 [177.7 µmol/L ± 78.7]; P = .006). Urinary N-acetyl-ß-glucosaminidase level did not change with theophylline administration but significantly (P = .034) increased 24 hours after contrast medium administration with the placebo.
CONCLUSION: Prophylactic administration of 200 mg theophylline reduces the incidence of contrast material–induced nephropathy in patients with chronic renal insufficiency.
© RSNA, 2002
Index terms: Angiography, complications, 81.1242, 81.44 • Contrast media, complications, 81.44 • Contrast media, effects, 81.44 • Coronary angiography, complications, 81.44 • Kidney, failure, 81.44 • Theophylline
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