Pharmacological interventions for the prevention of contrast-induced acute kidney injury in high-risk adult patients undergoing coronary angiography: A systematic review and meta-analysis of randomised controlled trials

Alexander J. Sharp*, Nishith Patel, Barney C. Reeves, Gianni D. Angelini, Francesca Fiorentino

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)

4 Citations (Scopus)
425 Downloads (Pure)

Abstract

Objective
Quantify the efficacy of strategies to prevent contrast-induced acute kidney injury (CI-AKI) in high-risk patients undergoing coronary angiography(CAG) with or without percutaneous coronary intervention (PCI).
Background
CI-AKI remains a common problem. The renoprotective efficacy of existing pharmacological agents remains uncertain in high-risk populations.
Methods
Systematic review and meta-analysis of randomized controlled trials(RCTs) to compare different strategies versus hydration in patients with chronic kidney disease (CKD) undergoing CAG+/-PCI. Primary outcome was incident CI-AKI. Fixed-effects meta-analyses estimated odds ratios(OR), 95% confidence intervals (CI), and heterogeneity.
Results
Forty-eight RCTs were included. Seven pharmacological strategies wereevaluated by multiple RCTs and 10 by one RCT each. These had varyingrisk of bias; >25% of trials were at high risk of performance bias. Five strategies significantly reduced the odds of CI-AKI: N-acetylcysteine (27trials, 5694 participants; OR=0.77, 95% CI 0.65-0.91, p=0.002,I2=36%), ascorbic acid (4 trials, 759 participants; OR=0.59, 95% CI0.39-0.89, p=0.01, I2=0%), statin (2 trials, 3234 participants; OR=0.59, 95% CI 0.39-0.89, p=0.75, I2=0%), trimetazidine (2 trials, 214participants; OR=0.27, 95% CI 0.10-0.71, p=0.01, I2=0%) and nicorandil(2 trials, 389 participants; OR=0.47, 95% CI 0.23-0.94, p=0.03,I2=52%). Theophylline had a similar, but non-significant, effect. A subgroup analysis found that the benefit of NAC was highest in patients requiring a high contrast dose.
Conclusions
Several drugs are renoprotective in CKD patients undergoing CAG+/-PCI. The evidence is strongest for NAC. We recommend that NAC should be used when a high dose of contrast is anticipated.
Original languageEnglish
Article numbere000864
Number of pages11
JournalOpen Heart
Volume6
Issue number1
Early online date25 Jan 2019
DOIs
Publication statusPublished - Jan 2019

Structured keywords

  • Bristol Heart Institute
  • Centre for Surgical Research
  • BTC (Bristol Trials Centre)

Keywords

  • Coronary angiography
  • coronary intervention (PCI)
  • contrast media
  • renal disease

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    NIHR BRC Cardiovascular

    Angelini, G. D.

    1/04/1731/03/22

    Project: Research, Parent

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