allopurinol prophylactic therapy and the prevention of contrast-induced nephropathy in high-risk patients undergoing coronary angiography: a prospective randomized controlled trial

BACKGROUND: Contrast-induced nephropathy (CIN) is considered to be a possibly severe complication of radiography and thus, remains to be the main cause of acute kidney injury (AKI) for inpatients. A clinical trial was executed to measure the preventive effect of allopurinol against CIN in high-risk patients undertaking coronary angiography.

METHODS: Through randomized controlled trial, 140 patients with at minimum two risk factors of CIN, undertaking coronary angiography, were randomly allocated to the allopurinol (n = 70) or control group (n = 70). Those in the allopurinol group received allopurinol (300 mg) a day before their coronary angiography and intravenous hydration for 12 hours before and after their procedure, while members of the control group only received intravenous hydration. Serum creatinine (SCr), blood urea nitrogen (BUN) and uric acid were measured before and 48 hours after the procedure. CIN was defined by a 25% increase in SCr or the concentration of > 0.5 mg/dl,
48 hours after coronary angiography.

RESULTS: CIN was observed in 8 (11.4%) patients in the allopurinol group and 11 (15.7%) patients in the control group. There was no significant difference in the incidence of CIN between the two groups at 48 hours after coronary angiography (P = 0.459). In the allopurinol group, the median SCr concentration decreased non-significantly from 1.16 mg/dl to 1.13 mg/dl, 48 hours after coronary angiography (P = 0.189). In the control group, the median SCr concentration increased significantly from 1.11 mg/dl to 1.2 mg/dl, 48 hours after coronary angiography (P < 0.001).

CONCLUSION: Allopurinol presents no considerable effectiveness over the hydration protocol for development of CIN in high-risk patients.