Trimetazidine reduces contrast-induced nephropathy in patients with renal insufficiency undergoing coronary angiography and angioplasty: A systematic review and meta-analysis (PRISMA)

Abstract

Objectives: This systematic review and meta-analysis assesses the utility of trimetazidine (TMZ) to prevent contrast induced nephropathy (CIN) in patients with renal insufficiency undergoing coronary angiography and angioplasty.

Materials and methods: This meta-analysis was formulated and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of databases was conducted by 2 researchers independently for clinical trials, comparing hydration plus TMZ vs conventional hydration alone for prevention of CIN through January 2020. All patients had renal insufficiency (defined as GFR < 89 ml/minute/1.73 m2) and the outcome of interest was the incidence of contrast induced acute kidney injury. The odds ratio (OR) was estimated with 95% confidence interval (CI). Heterogeneity was reported with the I2 statistic, using a fixed-effects model, and >50% of I2 was considered to be statistically significant.

Results: Eleven studies, 1611 patients, met the inclusion/exclusion criteria: 797 patients comprised the TMZ plus hydration group and the remaining 814 patients comprised the control (hydration only) group. Heterogeneity was low I2 = 0%, P = .84, and the heterogeneity of each study was also low. The incidence of CIN in the TMZ plus hydration group was 6.6% (53/797), while the incidence of CIN in the control (hydration only) group was 20% (165/814). Pooled analysis of all studies showed TMZ reduced incidence of CIN compared to saline hydration alone (OR risk 0.30, 95% CI 0.21, 0.42, P < .0001).

Conclusion: TMZ added to hydration reduces CIN in renal insufficiency patients undergoing coronary angiography.

Figure 1

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.

Figure 2

Forest plot of 11 randomized controlled trials showing low heterogeneity between studies: I² = 0%, P = .84. Overall, trimetazidine added to hydration reduced the incidence of contrast induced nephropathy compared to standard hydration therapy alone in patients with renal insufficiency OR:0.30, 95% confidence interval [CI] 0.21, 0.42, P < .000).

Figure 3

The results of the meta-analysis showed Low heterogeneity on both Asian and non-Asian groups: I² = 0%, P = .57, I² = 0%, P = .87 .Meta-analysis from both groups showed that trimetazidine added to hydration significantly reduces the incidence of contrast induced nephropathy, Asian population: OR 0.30, 95% confidence interval [CI] 0.2, 0.44, P < .000, non-Asian: OR 0.30, 95% confidence interval [CI] 0.17, 0.56, P < .000).

Figure 4

The results of the meta-analysis showed low heterogeneity on both iodixanol and non-iodixanol groups: I² = 0%, P = .55, I² = 0%, P = .63. Meta-analysis from both groups showed that Trimetazidine added to hydration significantly reduces the incidence of contrast induced nephropathy,Iodixanol: OR 0.4, 95% confidence interval [CI] 0.22, 0.70, P < .000, non-iodixanol: odds ratio 0.22, 95% confidence interval [CI] 0.13, 0.39, P < .000).