PGE-1 in addition to the standard care (statins) to prevent the renal injury after coronary angiography - is good ?

Can we give PGE-1 in addition to the standard care (statins) to prevent the renal injury after coronary angiography in mild to moderate CKD patients?

Prostaglandin E-1 is used to relieve the rest pain, heal ulcers in patients with non reconstructable critical ischemia. Prostaglandin E-1 is known to produce micro vasodilation and improve the metabolism of the tissues to relieve the symptoms and heal ulcers in ischemic patients. It has to be intravenously to get these benefits. Oral Prostaglandin E1 did not show similar benefits in these patients. Pulmonary hypertension in cardiac patients is also relieved by the PGE-1 in the perioperative periods. Contrast induced nephropathy (CIN) is a known complication after angiograms. We avoid this complication (CIN) - by properly hydrating the patients and giving N-acetyl cysteine. Coronary angiogram in mild to moderate CKD patients is associated with additional risk and there are no definite measures which can reduce the risk of worsening of renal failure. This has given opportunity for the Liu WJ et al from Shanghai to study benefits of adding PGE-1 to Statins to reduce the incidence of CIN in patients undergoing the coronary angiogram. They published their results recently and they are favourable.

In their study, a total of 156 consecutive patients with mild to moderate renal failure who underwent coronary angiography were enrolled in the study, and randomly categorized into two groups. In the statins group, 80 patients were treated with statins before and after coronary angiography. In the alprostadil plus statins group, 76 patients were treated with statins and alprostadil before and after coronary angiography. Serum creatinine (SCr), serum cystatin (CysC) and neutrophil gelatinase-associated lipocalin (NGAL) were detected after administration of contrast media, and adverse events were evaluated within six months. Inj. PGE-1 is given for 7 days (20mcg/day) started one day prior to coronary angiogram. In both groups, the SCr, CysC and NGAL significantly increased after coronary angiography and peaked at 48, 24 and 6 hours, respectively. SCr, CysC and NGAL were significantly lower in the alprostadil plus statins group than in the statins group (P < 0.05).

The incidence of CIN in the alprostadil plus statins group was slightly lower than in the statins group. The incidence of adverse events within six months in the alprostadil plus statins group was significantly lower than in the statins group (P = 0.034). They concluded by saying that Intravenous alprostadil in combination with oral statins is superior to statins alone for protecting renal function in patients with mild to moderate renal dysfunction who undergo coronary angiography, and can reduce the incidence of adverse events seen within six months.

Fig: Kaplan-Meier method was used to analyze the timing of adverse events during follow-up period. The incidence of adverse events was lower in the alprostadil plus statins group (group 2) than in the statins group (group 1) (P=0.034).

Chin Med J (Engl). 2013 Sep;126(18):3475-80. Renoprotective effect of alprostadil in combination with statins in patients with mild to moderate renal failure undergoing coronary angiography.Liu WJ, Zhang BC, Guo R, Wei YD, Li WM, Xu YW. Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.