The Prevention of Contrast Induced Nephropathy by Sarpogrelate: a Prospective Randomized Controlled Clinical Trial

Abstract

BackgroundAlthough some strategies are used for prophylaxis of contrast induced nephropathy, their efficacy is not fully established. Sarpogrelate can relieve vasospasm and have anti-inflammatory action. This study examined whether sarpogrelate reduces the incidence of contrast induced nephropathy (CIN) or subsequent renal impairment during four weeks after coronary angiography compared with a control group.MethodsSeventy-four participants with chronic renal failure were randomly assigned to the sarpogrelate or control group. Patients assigned to the sarpogrelate group received oral saporogelate from 24 hours before contrast exposure up to one month after contrast exposure. The primary outcome of this study was the incidence of CIN within 48 hours after exposure to the contrast agent.ResultsThirty-one subjects in the control group and 35 subjects in the sarpogrelate group were used for the analysis. Cumulative CIN occurred numerically more at 48 hours in the sarpogrelate group and less at one month without statistical significance (11.4% vs. 6.5% at 48 hours and 11.4% vs. 16.1% at one month, respectively). Baseline renal function was similar in both groups, but the estimated glomerular filtration rate (eGFR) was lower in the sarpogrelate group at 12 and 48 hours compared with the control group (45.6 vs. 54.7 mL/min/1.73m2; P = 0.023 and 39.9 vs. 50.6 mL/min/1.73m2; P = 0.020, respectively). At one month, the eGFR became comparable between the two groups because the eGFR was aggravated in the control group and maintained in the sarpogrelate group.ConclusionThis study failed to demonstrate that sarpogrelate has a renoprotective effect against contrast induced acute kidney injury.Trial RegistrationClinicalTrials.gov Identifier: NCT01165567

Ongoing Clinical Trials in Aging-Related Tissue Fibrosis and New Findings Related to AhR Pathways

“…Moreover, contrast-induced nephropathy is a serious health problem with increased morbidity and mortality, especially in patients with renal insufficiency. Sarpogrelate is a selective serotonin receptor subtype 2A antagonist that can block serotonin-induced platelet aggregation and has an anti-inflammatory effect, which has been shown to reduce renal fibrosis in animal models [ 145 , 146 ], while the clinical outcome of sarpogrelate in contrast induced nephropathy is disappointing [ 147 ]. Of most patients who experienced an adverse event during the above trials, fracture and gastrointestinal discomfort were reported by more patients in the treat group.…”

Prevention of contrast-associated acute kidney injury in cancer patients undergoing radiologic investigation using contrast media; a short-review to current knowledge

“…Pathophysiological viewpoint, iodinated contrast material stimulates vasoconstriction and also inflammation in this vulnerable vascular bed of renal medullary region leading to the creation of reactive oxygen species. Additionally, the exposure to contrast medium, decreases oxygen pressure in the deep renal medulla and simultaneously induces an increase in ion transport and oxygen utilization at the TAL (thick ascending limb) (13)(14)(15)(16). Accordingly, an increase in tubular pressure causes tubular obstruction which results in an enhanced oxygen consumption and worsening of ischemic damage (12)(13)(14)(15)(16)(17).…”

“…Additionally, the exposure to contrast medium, decreases oxygen pressure in the deep renal medulla and simultaneously induces an increase in ion transport and oxygen utilization at the TAL (thick ascending limb) (13)(14)(15)(16). Accordingly, an increase in tubular pressure causes tubular obstruction which results in an enhanced oxygen consumption and worsening of ischemic damage (12)(13)(14)(15)(16)(17). On the other hand, vasoconstriction imposes the oxidative damage which further intensifies the hypoxia in renal medullae, since the combined effects of low oxygen delivery due to vasoconstriction and high oxygen consumption in the proximal tubules render the renal medullae mainly vulnerable to hypoxic damage.…”

“…These substances also strengthen the creation and release of reactive oxygen species, which may result in direct cytotoxic consequences on kidney tubular cells. Additionally, hemodynamic instability, have been suggested (12)(13)(14)(15)(16)(17)(18)(19).…”

“…Some investigations have determined the presence of kidney insufficiency in individuals with solid tumors. Conversely, an increased incidence of cancer has been described in individuals with chronic kidney failure (55,56).…”