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

Abstract: Background: Contrast-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. Methods: We 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). Results: CIN 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. Conclusions: Prophylactic oral administration of allopurinol, along with hydration, may protect against CIN in high-risk patients undergoing coronary procedures. [Copyright &y& Elsevier]