Efficacy of allopurinol pretreatment for prevention of contrast-induced nephropathy: a randomized controlled trial

Abstract

BackgroundContrast-induced nephropathy (CIN) remains a common complication of radiographic procedures. Radiocontrast agents can cause a reduction in renal function that may be due to reactive oxygen species. Conflicting evidence suggests that administration of antioxidants prevents CIN. MethodsWe assessed the efficacy of allopurinol in preventing CIN. We prospectively randomized 159 patients with a serum creatinine concentration >1.1mg/dL undergoing cardiac catheterization/interventions to receive allopurinol (300mg, p.o.) 24h before administration of radiocontrast agent and hydration (1mg/kg/hN/saline for 12h pre- and post-contrast, n=79), or hydration alone (1mg/kg/hN/saline for 12h pre- and post-contrast, n=80). ResultsCIN occurred in 6 of 80 patients (7.5%) in the control group and no subjects in the allopurinol group (p=0.013). In the allopurinol group, median serum creatinine concentration decreased significantly from 1.43mg/dL [1.1–4.15mg/dL] to 1.35mg/dL [0.7–4.15mg/dl] at 48h and to 1.27mg/dL [0.66–4.37mg/dL] at 4days after radiocontrast administration (p<0.0001 and p<0.0001 compared with baseline, respectively). In the control group, median serum creatinine concentration decreased non-significantly from 1.48mg/dL [1.1–2.96mg/dL] to 1.43mg/dL [0.73–3.02mg/dL] and to 1.45mg/dL [0.86–3.71mg/dL] (p=0.045 and p=0.57, respectively) 48h and 4days after radiocontrast administration. ConclusionsProphylactic oral administration of allopurinol, along with hydration, may protect against CIN in high-risk patients undergoing coronary procedures.