Title of article :
Comparison between theophylline, N-acetylcysteine, and theophylline plus N-acetylcysteine for the prevention of contrast-induced nephropathy
Author/Authors :
Arabmomeni، Morteza نويسنده Cardiologist, Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran , , Najafian، Jamshid نويسنده Department of Cardiology, Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan , , Abdar Esfahani، Morteza نويسنده Cardiology Department, Isfahan University of Medical Sciences, Isfahan, IR Iran , , Samadi، Mohsen نويسنده Cardiologist, Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran , , Mirbagher، Leila نويسنده Medical Students’ Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran ,
Abstract :
BACKGROUND: Few studies compared the efficacy of theophylline with N-acetylcysteine or
evaluated the efficacy of combination therapy in the prevention of contrast-induced
nephropathy (CIN). We compared the efficacy of theophylline, N-acetylcysteine, and the
combination of these agents in the prevention of CIN.
METHODS: This randomized controlled trial was conducted on 96 patients referring
consecutively to the Shahid Chamran University Hospital in Isfahan, Iran, for elective coronary
angiography (with our without angioplasty). Patients with at least moderate risk for CIN were
included and were randomized to receive theophylline (200 mg), N-acetylcysteine (600 mg), or
theophylline + N-acetylcysteine, twice a day, from 24 h before to 48 h after administration of the
contrast material. A non-ionic, low-osmolar contrast material was used. Serum creatinine was
measured before and 48 h after contrast material injection.
RESULTS: Serum creatinine was increased by 6.83 ± 15.32% with theophylline, 13.09 ± 14.63%
with N-acetylcysteine, and 5.45 ±1 3.96% with theophylline + N-acetylcysteine after contrast
material injection (between group P = 0.072). Controlling for Mehran risk score, baseline serum
creatinine, and contrast volume, the change in serum creatinine level was lower with
theophylline compared with N-acetylcysteine (F = 4.79, P = 0.033), and with theophylline +
N-acetylcysteine compared with N-acetylcysteine (F = 5.78, P = 0.020). CIN (increase in
creatinine of ? 0.5 mg/dl or ? 25% from the baseline) was occurred in 20%, 21.9%, and 7.1% of
patients in the theophylline, N-acetylcysteine, and theophylline + N-acetylcysteine groups,
respectively (P = 0.260).
CONCLUSION: Theophylline is superior to N-acetylcysteine in preventing contrast-induced renal
dysfunction, but the combination with N-acetylcysteine is not superior to theophylline alone in
this regard. Further trials with larger sample of patients are warranted.
