Prostaglandin E-1 in impaired renal function

Background: Owing to generalized arteriosclerosis, changes in renal excretion are also to be expected in patients with peripheral arterial occlusive disease (PAOD). It is therefore recommended that in the presence of serum creatinine levels >1.5 mg/dl, prostaglandin E-1 therapy should be carefully monitored At the same time, experimental and clinical pilot studies have shown that prostaglandin E-1 has a positive influence on renal function. Against this background tolerability dosage and effect of PGE(1) on the serum creatinine levels were investigated in an analysis of the literature, and also checked in a retrospective survey of 10 angiological centers, Patients and methods: For the analysis of the literature, eight clinical studies on the use of PGE(1) in chronic renal insufficiency, in surgery of the heart and aorta, and following the administration of contrast medium, were analysed with respect to the influence of PGE(1) on renal function. The retrospective survey included 134 patients with PAOD and impaired renal function (serum creatinine levels > 1.5 mg/dl), of whom 103 were in stage Fontaine III/IV and 31 in stage II. The mean age was 71 +/- 10 years, the ankle arterial pressures in non-diabetics in stage III/IV were 40.5 +/- 45.0 mmHg. On average, the patients received either a single daily dose of 10 mu g PGE(1) i.a. (n = 42), or 2 x 40 mu g PGE(1) i.v. (n = 92) for an average period of 20 and 21 days respectively. Results: In all the published studies, the PGE(1) noses applied (up to 40 ng x kg x min) were well tolerated, and elevated serum creatinine levels were lowered creatinine clearance improved, and microalbuminuria reduced. The retrospective survey showed that one-quarter of the patients (25.2%) were returned from stage III/IV to stage II. Progression was recorded in 6.8% of the patients, the stage remained unchanged in 4,9%, while the remaining patients experienced partial healing of ulcers or a reduction in rest pain. Treatment was well tolerated; the serum creatinine levels, which on average were initially 2.02 mg/dl, showed no significant changes during the course of treatment. Conclusions: The PGE(1) dose recommended for PAOD is also well tolerated by patients with impaired renal function. Indeed results obtained in numerous pilot studies even suggest that renal function is likely to be improved by PGE(1) treatment.