Chronic kidney disease (CKD) is a major risk factor for contrast induced nephropathy acute kidney injury (CIN-AKI) in chronic coronary syndrome (CCS) patients undergoing coronary catheterization. We aimed to evaluate the efficacy of phentolamine in prevention of CIN-AKI in CKD and CCS patients undergoing percutaneous coronary catheterization for diagnostic angiography ± stenting.
Participants with CKD and CCS planned for percutaneous coronary catheterization were included, while participants with normal kidney functions were excluded. A consecutive sample of 107 participants (mean age 58.62 ± 8.96 years, 64.5% males) was selected, underwent diagnostic coronary angiography or percutaneous coronary intervention, and received either conventional CIN-AKI prevention strategy (group 1) or periprocedural phentolamine and conventional CIN-AKI prevention strategy (group 2).
The percentages of study participants who had CIN-AKI were 82.9% for group 1 and 17.1% for group 2, respectively. There were a statistically significant association between periprocedural phentolamine and prevention of CIN-AKI (OR = 0.041, 95% CI 0.0149–0.1128, P < 0.0001) and statistically significant differences between group 1 versus group 2 regarding the urine output (ml/kg) and the urine output (ml/hour) within 72 hours post procedure, the peak change in serum creatinine within 72 hours post procedure, the percentage of change relative to the baseline serum creatinine at 72 hours post procedure, and the incidence rate of major adverse cardiac and cerebrovascular events within 90 days post procedure (t(105)= -0.69, p < 0.001, t(105)= -52.46, p < 0.001, t(102) = 0.2, p 0.018, t(102) = 23.54, p < 0.001, and t(102) = 1.168, P < 0.001, respectively).
The incidence of CIN-AKI and the peak change in serum creatinine within 72 hours post procedure was lower in CKD patients who underwent coronary catherization and received phentolamine infusion versus intravenous saline. The significant association of phentolamine infusion with prevention of CIN-AKI highlights the potential role of phentolamine for protection of the kidney in CKD patients planned for coronary catherization.
Trial Registration Number:
Date of Trial Registration: 01/06/2016