MO351: Effect of Allopurinol Versus Saline Hydration in Preventing Contrast-Induced Nephropathy

Abstract

BACKGROUND AND AIMS Contrast-induced nephropathy (CIN) is a generally reversible form of acute kidney injury that occurs soon after the .administration of radiocontrast media. Several therapies are being used for the prevention of CIN. We aimed to gather the data about protective role of a single oral dose of Allupurinol along with hydration with normal saline as compared with normal saline only in our settings. METHOD Duration of study was 6 months. It was done at Department of Nephrology/Cardiology, Pakistan Institute of Medical Sciences (PIMS), SZABMU, Islamabad. In this randomized controlled trial, a total of 76 (n = 76) adult (age 18–75 years) patients of either gender who were planned to undergo coronary intervention were selected for this study. All the enrolled patients had an eGFR <60 mL/min. Participants were divided into two groups randomly by using random number tables. Patients in group A received a single dose of 300 mg Allopurinol orally 12 h before contrast-based procedure and intravenous normal saline hydration at the rate of 0.5 mL/kg/h in continuous infusion 12 h before and 12 h after contrast-based procedure. Group B received normal saline hydration alone in dose equal to group A. Blood samples were drawn 12 h before procedure. Samples were analyzed for serum creatinine levels. Blood samples were drawn after 48 h and 5 days of procedure for serum creatinine analysis. CIN was assessed in all patients, which was defined as an absolute .increase in .serum creatinine level of > 0.05 mg/dL or a relative increase of > 25% from baseline at 48 h after contrast exposure and compared in both treatment groups. RESULTS Gender distribution was similar in both groups with M:F of 1.71 in group A and 1.53 in group B (P = 0.813). Mean age was 57.6 years ± 7.4 SD in group A, while it was 58.4 years ± 6.5 SD in group B (P = 0.612). There were 63.2% (n = 24/38) patients in group A who were between ≤60 years of age and 36.8% (n = 14/38) had an age >60 years. Mean eGFR at baseline in group A was 53.7 mL/min ± 4.7 SD, and it was 54.8 mL/min/1.73 m2 ± 3.8 SD in group B (P = 0.277). Mean maximal allowable contrast dose (MACD) in group A was 323.3 mL ± 51.7 SD, and it was 313.4 mL ± 0.09 SD in group B (P = 0.445). Mean contrast volume was 55.1 mL ± 5.9 SD in group A, and it was 56.9 mL ± 5.6 SD in group B (P = 0.171). The mean CV/MACD ratio was similar in both groups (0.17 versus 0.19, P = 0.160, Table 7). Contrast-induced nephropathy (CIN) was observed in 5.3% (n = 2/38) patients in group A, while it was observed in 21.1% (n = 8/38) patients in group B as per pour operational definitions (P = 0.042). CIN in both the groups were stratified with respect to age, gender, BMI and baseline comorbids. In patients with baseline uric acid within normal limits, CIN was observed in 3.4% (n = 1/29) patients in group A, while it was observed in 9.7% (n = 3/31) patients in group B (P = 0.334, Table 10). In patients with raised uric acid levels at baseline, CIN was observed in 11.1% (n = 1/9) patients in group A, while it was observed in 71.4% (n = 5/7) patients in group B (P = 0.013). Efficacy of a single dose of Allopurinol dose along with hydration with normal saline was significantly better in patients with raised serum uric acid levels at baseline when compared with normal saline only (P = 0.013). No other significant difference noted across all groups (P>0.05 in all cases). CONCLUSION CIN developed in a significantly lesser number of patients who received a single dose of 30 mg of Allopurinol 12 h before administration of contrast along with saline hydration as compared with patients receiving hydration alone.