Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan 25;6(1):e000864.
doi: 10.1136/openhrt-2018-000864. eCollection 2019.

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  1 , Nishith Patel  2 , Barney C Reeves  3 , Gianni D Angelini  4 , Francesca Fiorentino  5
Affiliations

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 et al. Open Heart. .

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 randomised 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 ORs, 95% CIs and heterogeneity.

Results: Forty-eight RCTs were included. Seven pharmacological strategies were evaluated by multiple RCTs and 10 by one RCT each. These had varying risk of bias; >25% of trials were at high risk of performance bias. Five strategies significantly reduced the odds of CI-AKI: N-acetylcysteine (NAC) (27 trials, 5694 participants; OR=0.77, 95% CI 0.65 to 0.91, p=0.002, I2=36%), ascorbic acid (four trials, 759 participants; OR=0.59, 95% CI 0.39 to 0.89, p=0.01, I2=0%), statin (two trials, 3234 participants; OR=0.59, 95% CI 0.39 to 0.89, p=0.75, I2=0%), trimetazidine (two trials, 214 participants; OR=0.27, 95% CI 0.10 to 0.71, p=0.01, I2=0%) and nicorandil (two trials, 389 participants; OR=0.47, 95% CI 0.23 to 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 patients with CKD undergoing CAG±PCI. The evidence is strongest for NAC. We recommend that NAC should be used when a high dose of contrast is anticipated.

Trial registration number: PROSPERO registration CRD42014014704.Open Science Framework link: https://osf.io/vxg7d/?view_only=62bad0404b18405abd39ff2ead2575a8.

Keywords: Coronary angiography; contrast media; coronary intervention (PCI); renal disease.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram of search strategy. CAG, coronary angiography; CKD, chronic kidney disease; RCT, randomised controlled trial.
Figure 2
Figure 2
Methodological quality graph – authors’ judgement on risk of bias associated with each methodological quality item presented as a percentage across all included studies.
Figure 3
Figure 3
Forest plot of drugs (experimental) versus hydration with saline (control) in incidence of contrast-induced acute kidney injury.
See this image and copyright information in PMC

References

    1. Tsai TT, Patel UD, Chang TI, et al. . Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv 2014;7:1–9. 10.1016/j.jcin.2013.06.016 - DOI - PMC - PubMed
    1. Crimi G, Leonardi S, Costa F, et al. . Incidence, prognostic impact, and optimal definition of contrast-induced acute kidney injury in consecutive patients with stable or unstable coronary artery disease undergoing percutaneous coronary intervention. insights from the all-comer PRODIGY trial. Catheter Cardiovasc Interv 2015;86:E19–E27. 10.1002/ccd.25822 - DOI - PubMed
    1. McCullough PA. Contrast-induced acute kidney injury. J Am Coll Cardiol 2008;51:1419–28. 10.1016/j.jacc.2007.12.035 - DOI - PubMed
    1. KDIGOKAKIW KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int 2012;(Suppl 2):1–138.
    1. McCullough PA, Adam A, Becker CR, et al. . Epidemiology and prognostic implications of contrast-induced nephropathy. Am J Cardiol 2006;98(6):5–13. 10.1016/j.amjcard.2006.01.019 - DOI - PubMed

Publication types