SPECIAL SECTIONS: LETTERS TO THE EDITOR
Reply
Morris Mosseri, MDa,
Meir Gare, MDa and
Devorah Rubinger, MDa
a Prairie Cardiology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Thank you for your interest in our article on the renal effect of low-dose dopamine in high-risk patients undergoing coronary angiography (1). We found no important renal protective effect of dopamine in patients at high risk for contrast nephropathy (CN) undergoing coronary angiography. We agree that the vasodilator effect of low-dose dopamine may be too small to counteract the afferent arteriolar vasoconstriction induced by the contrast medium. Higher doses of dopamine, however, may contribute to even more severe vasoconstriction.
We have also been interested in the adenosine receptor blocking effect of theophylline. We found that the acute renal failure induced by indomethacin and contrast medium in rats with diabetes mellitus (DM) was mediated by adenosine via suppression of renal and/or systemic NO2–/NO3 production and that theophylline reversed NO2–/NO3 secretion to levels similar to those of DM rats (2). The role of theophylline as a means of reducing CN in the clinical setting, however, is not well defined. Although Katholi (3) and Kolonko (4) have found some beneficial effect of theophylline, more recent studies focusing on higher-risk patients failed to demonstrate such effect. Abizaid et al. (5) found that neither aminophylline nor dopamine reduced the incidence of CN compared with saline hydration alone, in patients with serum creatinine  1.5 mg/dl. Erley et al. (whose previous study was cited by Katholi and Taylor in their present Letter to the Editor) randomized 80 patients with serum creatinine 1.5 mg/dl to either 810 mg of theophylline daily or placebo (6). They found that hydration alone was sufficient to preserve glomerular filtration and that theophylline had no additional benefit; they suggested that theophylline might be beneficial in patients for whom sufficient hydration is difficult, such as patients with severe congestive heart failure (6). Such patients, however, are usually treated with multiple medications, and adding theophylline at a sufficient dose may be accompanied by intolerable side effects.
Therefore, it seems to us that the advantages of theophylline in reducing the detrimental effect of contrast media, especially in high-risk patients, have yet to be proven. The prevention of CN in patients receiving contrast media should be based, at the present time, on adequate hydration accompanied by diuresis when needed.
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References
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- Gare M, Haviv YS, Ben Yehuda A, et al. The renal effect of low-dose dopamine in high-risk patients undergoing coronary angiography. J Am Coll Cardiol. 1999;34:1682–1688[Abstract/Free Full Text]
- Rubinger D, Scherzer P, Hochman O, Aronson A, Popovtzer MM. Adenosine antagonism prevents contrast nephropathy in experimental diabetes mellitus by activation of the NO system. J Am Soc Nephrol. 1999;10:689A
- Katholi RE, Taylor GJ, McCann WP, et al. Nephrotoxicity from contrast media: attenuation with theophylline. Radiology. 1995;195:17–22[Abstract/Free Full Text]
- Kolonko A, Wiecek A, Kokof F. The nonselective adenosine antagonist theophylline does prevent renal dysfunction induced by radiographic contrast agents. J Nephrol. 1998;11:151–156[Medline]
- Abizaid AS, Clark CE, Mintz GS, et al. Effects of dopamine and aminophylline on contrast-induced acute renal failure after coronary angioplasty in patients with preexisting renal insufficiency. Am J Cardiol. 1999;83:260–263[CrossRef][Medline]
- Erley CM, Duda SH, Rehfuss D, et al. Prevention of radiocontrast media-induced nephropathy in patients with pre-existing renal insufficiency by hydration in combination with the adenosine antagonist theophylline. Nephrol Dial Transplant. 1999;14:1146–1149[Abstract/Free Full Text]
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