A Review of the Use of Iloprost, A Synthetic Prostacyclin, in the Prevention of Radiocontrast Nephropathy in Patients Undergoing Coronary Angiography and Intervention (original) (raw)
Related papers
Circulation, 2009
Background— The prevention of contrast-induced nephropathy, which accounts for considerable morbidity and mortality, remains a vexing problem. Contrast-induced renal vasoconstriction is believed to play a pivotal role in the pathogenesis of contrast-induced nephropathy. The aim of this study was to examine the efficacy of the prostacyclin analog iloprost in preventing contrast-induced nephropathy in patients with renal dysfunction undergoing a coronary procedure. Methods and Results— We conducted a randomized, double-blind, placebo-controlled trial of iloprost in 208 patients with a serum creatinine concentration ≥1.4 mg/dL who underwent coronary angiography and/or intervention. Iloprost 1 ng · kg −1 · min −1 or placebo was administered intravenously beginning 30 to 90 minutes before and ending 4 hours after the procedure. Contrast-induced nephropathy was defined by an absolute increase in serum creatinine ≥0.5 mg/dL or a relative increase ≥25% measured 2 to 5 days after the procedu...
European Journal of Clinical Pharmacology, 2006
Objective: The prevention of contrast-mediated nephropathy (CMN), which accounts for considerable morbidity and mortality, remains a vexing problem. Contrast induced renal vasoconstriction is believed to play a pivotal role in the CMN mechanism. The aim of this pilot study was to examine the safety and efficacy of two doses of the prostacyclin analogue iloprost in preventing CMN in high-risk patients undergoing a coronary procedure. Methods: Forty-five patients undergoing coronary angiography and/or intervention who had a serum creatinine concentration ≥1.4 mg/dL were randomized to receive iloprost at 1 or 2 ng/kg/min or placebo, beginning 30-90 minutes before and terminating 4 hours after the procedure. CMN was defined by an absolute increase of serum creatinine ≥0.5 mg/dL or a relative increase of ≥25% measured 2 to 5 days after the procedure. Study drug infusion was discontinued in 2 patients in the low-dose iloprost group due to flush/nausea and in 5 patients in the high-dose group due to severe hypotension. Results: The mean creatinine concentration change in the placebo group (0.02 mg/dL) was unfavorable compared to that in the low-dose iloprost group (−0.11 mg/dL; p=0.08) and high-dose iloprost group (−0.23 mg/dL; p=0.048). The difference between the absolute changes in creatinine clearance was favorable compared to placebo for both the low (mean difference 6.1 mL/min, 95%CI −0.5 to 12.8 mL/min, p=0.07) and the high-dose iloprost group (11.8 mL/min, 95%CI 4.7 to 18.8 mL/min, p=0.002). Three cases of CMN were recorded; all in the placebo group (p=0.032). Conclusions: The results of this pilot study suggest that prophylactic administration of iloprost may effectively prevent CMN, but higher dosages are connected with substantial tolerability issues.
Annals of Thoracic and Cardiovascular Surgery, 2013
Renal dysfunction remains a serious complication of coronary artery bypass grafting (CABG) surgery and is associated with increased mortality and morbidity. To date, a number of different strategies, including new pharmacologic agents, off-pump and cardiopulmonary bypass techniques have been used to avoid it, but none of them proves the excellent result. Methods: Between April 2009 to September 2011, 185 consecutive patients with multivessel coronary artery disease undergoing elective CABG were included the study. Iloprost was given with the onset of rewarming period at a dose of 1.25-2.5 ng/kg/min and it was ended together with the ending of CPB in 94 patients and remaining were in the control group. Creatinine clearance (CCr) and GFR were measured at the time of hospitalisation and on day first and fifth postoperatively. Serum potassium level was determined every 6 hours, during the first 24 hours postoperatively, and every 12 hours for the next 72 hours, and glomerular filtration rate was estimated. Results: There was no statistically significant difference in preoperative comorbidity. There were no significant differences in postoperative morbidity or mortality between either of the two groups that completed the study. However, urine output during the operation was significantly higher in the study group. An increase in creatine levels was more common in the control group. Development of a new CCr less than 50 ml/min was also significantly higher in the control group, postoperatively. Conclusion: Our study demonstrates that prophylactic intravenous iloprost administration after initiation of a rewarming period during CPB in patients undergoing CABG surgery is associated with improved renal function, compared with conventional treatment in wellhydrated patients. It also has a good safety profile and is generally well tolerated.
Detection and treatment of coronary artery disease in renal transplantation candidates
Transplantation Proceedings, 2002
D URING THE PAST three decades, despite the gradual but significant increase in the number of diabetics, elderly, and sick patients as renal transplant (Tx) recipients, the mortality rate following renal Tx has markedly decreased. Meanwhile, the main cause of death has changed from infection to cardiovascular disease (CVD). According to US Renal Data System, CVD is the most common cause of death in renal Tx recipients. 1 This finding is due to high prevalence of coronary artery disease (CAD) in this population. The risk is significantly higher among diabetic recipients. Reports from European Dialysis and Transplantation Association (EDTA) registry have also repeatedly emphasized the importance of CVD as the leading cause of death in both dialysis patients and renal Tx recipients, the incidence being higher than infectious causes. As almost all Tx recipients who die with CVD have a functioning graft, their death not only decreases the rate of patient survival but also graft survival. In a study from Scandinavia, Lindholm et al reported 49% graft loss due to patient death versus 41% due to rejection during the 2-to 5-year follow-up period of 1347 renal Tx recipients. 3 Fiftythree percent of deaths with a functioning graft were due to ischemic heart disease (IHD) and 10% due to other vascular events. Thus, more grafts were lost with patient mortality, secondary to cardiac death than due to graft rejection. So it is expected that in future further advances to increase long-term patient and graft survival rates will be dependent on prevention and treatment of CVD rather than on prevention and treatment of infections or immunosuppressive therapies. High prevalence of CAD (40%), left ventricular hypertrophy (LVH) (75%), and congestive heart failure (CHF) (40%) before Tx is the most important cause of increased cardiovascular mortality in renal Tx recipients. CAD and LVH are precursors of cardiovascular death and CHF is an independent predictor of cardiovascular mortality. 5 The traditional risk factors of CVD, such as hypertension, diabetes, hyperlipidemia, and hyperhomocysteinemia, are also very common before and after renal transplantation. Nonatherosclerotic cardiovascular structural changes specific to renal failure or uremic vasculopathy characterized by reduced capillary density, arteriolar wall thickening, and interstitial fibrosis of the heart has been shown in these patients. The high prevalence of traditional risk factors of CVD not only does not decrease after transplantation but also becomes exacerbated by immunosuppressive drugs, such as cyclosporine, tacrolimus, sirolimus, and steroids.
Iloprost as an acute kidney injury-triggering agent in severely atherosclerotic patients
Cardiovascular Journal of Africa, 2016
Background: Iloprost, a stable prostacyclin analog, is used as a rescue therapy for severe peripheral arterial disease (PAD). It has systemic vasodilatory and anti-aggregant effects, with severe vasodilatation potentially causing organ ischaemia when severe atherosclerosis is the underlying cause. In this study, we retrospectively analysed renal outcomes after iloprost infusion therapy in 86 patients. Methods: Eighty-six patients with PAD who received iloprost infusion therapy were retrospectively analysed. Clinical and biochemical parameters were recorded before (initial, Cr1), during (third day, Cr2), and after (14th day following the termination of infusion therapy, Cr3) treatment. Acute kidney injury (AKI) was defined according to KDIGO guidelines as a ≥ 0.3 mg/dl (26.52 μmol/l) increase in creatinine levels from baseline within 48 hours. Results: Cr2 (1.46 ± 0.1 mg/dl) (129.06 ± 8.84 μmol/l) and Cr3 (1.53 ± 0.12 mg/dl) (135.25 ± 10.61 μmol/l) creatinine levels were significantly higher compared to the initial value (1.15 ± 0.6 mg/dl) (101.66 ± 53.04 μmol/l). AKI was observed in 36 patients (41.86%) on the third day of iloprost infusion. Logistic regression analysis revealed smoking and not using acetylsalicylic acid as primary predictors (p = 0.02 and p = 0.008, respectively) of AKI during iloprost treatment. On the third infusion day, patients' urinary output significantly increased (1813.30 ± 1123.46 vs 1545.17 ± 873.00 cm 3) and diastolic blood pressure significantly decreased (70.07 ± 15.50 vs 74.14 ± 9.42 mmHg) from their initial values. Conclusion: While iloprost treatment is effective in patients with PAD who are not suitable for surgery, severe systemic vasodilatation can cause renal ischaemia, resulting in nonoliguric AKI. Smoking, no acetylsalicylic acid use, and lower diastolic blood pressure are the clinical risk factors for AKI during iloprost treatment.
Iloprost in Acute Post-kidney Transplant Atheroembolism: A Case Report of Two Successful Treatments
Frontiers in Medicine, 2020
Cholesterol embolization (CE) is a rare and alarming post-transplant complication, responsible for primary non-function (PNF) or delayed graft function (DGF). Its incidence is expected to rise due to increasingly old donors and recipients and the extended criteria for donation. Therapy with statins and steroids has not been shown to be effective, while agonism of prostaglandin I 2 has been reported to be useful in systemic CE. We report two cases of acute post-transplant CE in which intravenous iloprost (0.05 mg/kg/day) was added to standard statin and steroid therapy. In the first instance, CE was due to embolization from the kidney artery resulting in embolization of the small vessels; after a long DGF and 15 days of iloprost therapy, renal function recovered. The second instance is a case of embolization from the iliac artery of the recipient, where CE manifested as a partial renal infarction. After 5 days of iloprost administration, creatinine levels improved. Iloprost acts on vasodilation and on different inflammatory pathways, improving the anti-inflammatory profile. Post-transplant CE is difficult to diagnose and, if not treated, can lead to loss of function. Iloprost added to standard therapy could be beneficial in accelerating renal function recovery immediately after transplant.
Iloprost Added to the Cardioplegic Solutions Improves Myocardial Performance
Prostaglandins & Other Lipid Mediators, 1998
A total of 12 mongrel dogs were divided into two equal groups. Six animals received IIoprost and the other 6 animals did not receive any additional treatment. In the Iloprost group, Iloprost was added to the cardioplegic solution (25 ng). Also, Iloprost was used (10 ng/kg/min.) 5 min. before and after cross-clamping.
BMJ open, 2016
Acute kidney injury (AKI) after cardiac surgery is common and results in increased morbidity and mortality. One possible mechanism for AKI is ischaemia-reperfusion injury caused by the extracorporeal circulation (ECC), resulting in an opening of the mitochondrial permeability transition pore (mPTP) in the kidneys, which can lead to cell injury or cell death. Ciclosporin may block the opening of mPTP if administered before the ischaemia-reperfusion injury. We hypothesised that ciclosporin given before the start of ECC in cardiac surgery can decrease the degree of AKI. Ciclosporin to Protect Renal function In Cardiac Surgery (CiPRICS) study is an investigator-initiated double-blind, randomised, placebo-controlled, parallel design, single-centre study performed at a tertiary university hospital. The primary objective is to assess the safety and efficacy of ciclosporin to limit the degree of AKI in patients undergoing coronary artery bypass grafting surgery. We aim to evaluate 150 patie...