Evaluation of Pentoxifylline in the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Primary Percutaneous Coronary Intervention

As percutaneous coronary intervention (PCI) technologies confer increasing patient advantage, the use of iodinated contrast media for diagnostic and interventional procedures is increased. Although contrast media obstacles are transient and mild, contrast-induced nephropathy (CIN) negatively affects long-term patient mortality. PCI creates a high-risk condition for the incidence of CIN even in patients with a normal renal function. Pentoxifylline (PTX) with a variety of mechanisms may prevent CIN. We sought to assess the positive effect of PTX administration at the beginning prior to contrast media use to 24 hours after PCI to prevent CIN in patients with STEMI.
In this double-blind, single-center, clinical trial, we randomly assigned 296 consecutive patients to the control group (n=148) without PTX and the case group (n=148) with PTX 400 mg/tid at the time of hospitalization to 24 hours after the procedure. Serum creatinine was measured before and 48 hours after the procedure. The occurrence of CIN within 48 hours was our end point. CIN was defined as a 0.5 mg/dL increase or more in serum creatinine or a 25% increase or more above baseline serum creatinine.
A total of 296 patients were enrolled in this trial and were randomly assigned to receive either primary PCI plus PTX or only primary PCI. Out of 148 patients who received PTX, only 12.2% were seen to have CIN incidence (>0.5 mg/dL or a 25% increase in the Cr level); however, the difference between the 2 groups regarding CIN was not significant (P=0.4). Out of the 296 patients, only 20 were found to have chronic kidney disease (CKD) (CKD was defined as baseline Cr>1.5); and of those patients, 3 (15%) showed CIN incidence. Nevertheless, the difference between the 2 groups regarding CIN incidence was not significant (P=0.7). The regression test showed that between all confounding factors in the 2 groups of PTX positive and negative, sex and ejection fraction had positive effects on the rise in the Cr level and, consequently, the incidence of CIN (95% CI: 1.60 to 30.85; P=0.01 and 95% CI: 0.92 to 1; P=0.05).
Administration of oral PTX to patients with increased risk for CIN scheduled for primary PCI may not reduce the Cr level and thus the occurrence of CIN. Given the higher prevalence of hypotension in the patients without PTX, higher prevalence of CKD in the patients without PTX, and absence of significant difference between the 2 groups regarding the incidence of CIN, PTX had no preventive effect on CIN occurrence in STEMI. Among all factors influencing CIN occurrence, sex and ejection fraction had positive effects on the rise in the Cr level. 