Does Prophylactic Treatment with Felodipine, a Calcium Antagonist, Prevent Low-Osmolar Contrast-Induced Renal Dysfunction in Hydrated Diabetic and Nondiabetic Patients with Normal or Moderately Reduced Renal Function?

Abstract

Twenty-seven patients (15 diabetics and 12 non-diabetics) with normal to moderately reduced renal function underwent femoral angiography with a low-osmolar contrast agent, iohexol (Omnipaque), under perexaminatory hydration. Fourteen patients were randomised to pretreatment with oral felodipine extended release (Plendil) 10 mg and 13 patients to placebo 3-4 h before angiography. GFR measured with [51Cr] EDTA-clearance decreased 24 hours after the angiography in the felodipine group from GFR 52.5 +/- 18.6 (mean +/- SD) to 46.2 +/- 16.5 ml/min (p < 0.01) and in the placebo group from 70.6 +/- 18.6 to 62.6 +/- 26.4 ml/min (p < 0.01). Serum creatinine increased significantly in the felodipine group from 128 +/- 61 to 139 +/- 67 mumol/l (p < 0.05) but not in the placebo group (122 +/- 54 to 125 +/- 51 mumol/l (ns)). The values of serum creatinine returned to baseline levels 7 days after angiography. During hydration there was only a slight reduction of GFR after angiography with iohexol. Thus, felodipine had no major effect on GFR after iohexol but, as baseline GFR tended to be lower in the felodipine pre-treated patients, it might have had some renoprotective effect in patients with more advanced renal failure.

Contrast-Induced Nephropathy

“…Indeed, there was a significant rise in serum creatinine levels in the felodipine group, which was not seen in the placebo group ( p < 0.05) [121].…”

Acute Kidney Injury by Radiographic Contrast Media: Pathogenesis and Prevention

“…But their use has given controversial results, sometimes protective [182, 183] and sometimes with no benefit at all [178, 184]. …”

Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies

“…74 However, when the efficacy of the dihydropyridine calcium-channel blockers felodipine, nitrendipine and nifedipine was evaluated, results were inconsistent. 75,76 Endothelin-1, a potent endogenous vasoconstrictor, is thought to play a role in the development of contrastmedium nephropathy. However, the use of a mixed endothelin A and B antagonist (SB 290670) was associated with a significantly higher incidence of nephropathy than was placebo.…”