Effect of remote ischemic preconditioning, nicorandil, and trimetazidine in contrast-induced nephropathy: a network meta-analysis of randomized controlled trials.

IF 3 3区医学 Q1 UROLOGY & NEPHROLOGY Renal Failure Pub Date : 2024-12-01 Epub Date: 2024-11-27 DOI:10.1080/0886022X.2024.2431141

Hanchao Gao, Weilong Li, Chuanchuan Sun, Shiping Zhu, Fanna Liu, Xinhai Zhao, Shaodong Luan, Shengyun Sun, Yeye Yu

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Abstract

Introduction: Contrast-induced nephropathy (CIN) is a potential complication associated with the administration of intravenous contrast agents. The objective of this study was to evaluate the effectiveness of remote ischemic preconditioning (RIPC) and two pharmacological interventions in preventing CIN.

Methods: Randomized controlled trials (RCTs) examining the efficacy of RIPC, nicorandil, and trimetazidine in treating CIN were searched within databases such as PubMed, Cochrane Library, Embase, and Web of Science. The primary outcome was the incidence of CIN. The consistency model was used to address heterogeneity and enhance model fit. The assessment of consistency between direct and indirect evidence was conducted through the node-splitting method. Posterior probability estimates and surface under the cumulative ranking area (SUCRA) ranked interventions based on their effectiveness in preventing CIN. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used to grade the quality of evidence.

Results: Based on hydration therapy, RIPC, nicorandil, and trimetazidine all showed prophylactic effects on CIN compared to control groups. The SUCRA results showed that RIPC (SUCRA = 37.7%, PrBest = 0.4%), nicorandil (SUCRA = 91.2%, PrBest = 74.7%), and trimetazidine (SUCRA = 71.0%, PrBest = 24.9%). However, there were no significant differences between the nicorandil, RIPC, and trimetazidine groups. Subgroup analysis suggested that there was still a protective effect in populations with mean estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m² or with a high prevalence of diabetes mellitus.

Conclusions: Nicorandil, trimetazidine, and RIPC all showed renal protective effects. Based on hydration, nicorandil, trimetazidine, and RIPC may show better prophylaxis against CIN than hydration alone after intravenous contrast administration.

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远程缺血预处理、尼可地尔和曲美他嗪对造影剂诱发肾病的影响：随机对照试验的网络荟萃分析。

简介造影剂诱发肾病（CIN）是静脉注射造影剂的潜在并发症。本研究旨在评估远端缺血预处理（RIPC）和两种药物干预对预防 CIN 的有效性：方法：在 PubMed、Cochrane Library、Embase 和 Web of Science 等数据库中检索了研究 RIPC、尼可地尔和曲美他嗪治疗 CIN 疗效的随机对照试验 (RCT)。主要结果是 CIN 的发生率。一致性模型用于解决异质性问题并提高模型拟合度。通过节点分割法评估直接证据和间接证据之间的一致性。后验概率估计值和累积排序面积下表面（SUCRA）根据干预措施在预防 CIN 方面的有效性对其进行排序。采用推荐、评估、发展和评价分级（GRADE）框架对证据质量进行分级：结果：根据水化疗法，与对照组相比，RIPC、尼可地尔和曲美他嗪均显示出对 CIN 的预防效果。SUCRA 结果显示，RIPC（SUCRA = 37.7%，PrBest = 0.4%）、尼可地尔（SUCRA = 91.2%，PrBest = 74.7%）和曲美他嗪（SUCRA = 71.0%，PrBest = 24.9%）具有预防作用。然而，尼可地尔组、RIPC 组和曲美他嗪组之间没有明显差异。亚组分析表明，在平均估计肾小球滤过率（eGFR）低于 60 mL/min/1.73 m2 或糖尿病发病率较高的人群中仍有保护作用：尼可地尔、曲美他嗪和 RIPC 均具有肾脏保护作用。在补水的基础上，尼可地尔、曲美他嗪和 RIPC 对 CIN 的预防效果可能比静脉注射造影剂后单独补水更好。

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来源期刊

Renal Failure 医学-泌尿学与肾脏学

CiteScore

3.90

自引率

13.30%

发文量

374

审稿时长

1 months

期刊介绍： Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.