Efficacy of allopurinol pretreatment for prevention of contrast-induced nephropathy: a randomized controlled trial

Abstract Background Contrast-induced nephropathy (CIN) remains a common complication of radiographic procedures. Radiocontrast agents can cause a reduction in renal function that may be due to reactive oxygen species. Conflicting evidence suggests that administration of antioxidants prevents CIN. Methods We assessed the efficacy of allopurinol in preventing CIN. We prospectively randomized 159 patients with a serum creatinine concentration > 1.1 mg/dL undergoing cardiac catheterization/interventions to receive allopurinol (300 mg, p.o.) 24 h before administration of radiocontrast agent and hydration (1 mg/kg/h N/saline for 12 h pre- and post-contrast, n = 79), or hydration alone (1 mg/kg/h N/saline for 12 h pre- and post-contrast, n = 80). Results CIN occurred in 6 of 80 patients (7.5%) in the control group and no subjects in the allopurinol group (p = 0.013). In the allopurinol group, median serum creatinine concentration decreased significantly from 1.43 mg/dL [1.1–4.15 mg/dL] to 1.35 mg/dL [0.7–4.15 mg/dl] at 48 h and to 1.27 mg/dL [0.66–4.37 mg/dL] at 4 days after radiocontrast administration (p < 0.0001 and p < 0.0001 compared with baseline, respectively). In the control group, median serum creatinine concentration decreased non-significantly from 1.48 mg/dL [1.1–2.96 mg/dL] to 1.43 mg/dL [0.73–3.02 mg/dL] and to 1.45 mg/dL [0.86–3.71 mg/dL] (p = 0.045 and p = 0.57, respectively) 48 h and 4 days after radiocontrast administration. Conclusions Prophylactic oral administration of allopurinol, along with hydration, may protect against CIN in high-risk patients undergoing coronary procedures.