Effect of theophylline on contrast material-induced nephropathy in patients with chronic renal insufficiency: Controlled, randomized, double-blinded study

PURPOSE: To investigate whether the adenosine antagonist theophylline reduces the incidence of contrast material-induced nephropathy (serum creatinine level increase of at least 0.5 mg/dL [44.2 mumol/L] in 48 hours) in high-risk patients who have chronic renal insufficiency and have received at least 100 mL of contrast medium. MATERIALS AND METHODS: One hundred patients with serum creatinine levels of 1.3 mg/dL (114.3 mumol/L) or greater were randomly assigned to intravenously receive 200 mg theophylline or saline 30 minutes before administration of 100 mL or more of low-osmolarity contrast medium arterially (72 [72%] patients) or intravenously (28 [28%] patients). RESULTS: Patients receiving theophylline and control subjects were comparable with regard to risk factors for contrast-induced nephropathy such as mean serum creatinine level before contrast medium administration (2.07 mg/dL +/- 0.94 [SD] [182.9 mumol/L +/- 83.1] vs 1.92 mg/dL +/- 0.76 [169.7 mumol/l +/- 67.2], respectively), amount of contrast medium (196.5 mL +/- 84.1 vs 216.6 mL +/- 95.0, respectively), and diabetes prevalence. Theophylline prophylaxis significantly reduced the incidence of contrast material-induced nephropathy (4% vs 16%; P = .046). With theophylline, the mean serum creatinine level decreased nonsignificantly 12 (1.98 mg/dL +/- 0.77 [175.0 mumol/L 68.1]; P = .09), 24 (1.97 mg/dL +/- 0.75 [174.1 mumol/l +/- 68.1]; P.99), and 48 (1.94 mg/dL +/- 0.77 [171.5 mumol/L +/- 68.11; P = .99)(1.94 mg/dL +/- 0.77 [171.5 mumol/L +/- 68.1]; P = .99) hours after contrast medium administration. With a placebo, serum creatinine level significantly increased 24 hours after contrast medium administration (2.01 mg/dL 0.89 [177.7 mumol/L +/- 78.7]; P = .006). Urinary N-acetyl-beta-glucosaminidase level did not change with theophylline administration but significantly (P = .034) increased 24 hours after contrast medium administration with the placebo. CONCLUSION: Prophylactic administration of 200 mg theophylline reduces the incidence of contrast material-induced nephropathy in patients with chronic renal insufficiency. (C) RSNA, 2002.