The effect of alprostadil on preventing contrast-induced nephropathy for percutaneous coronary intervention in diabetic patients

Abstract

Background:At present, there are a lot of research about the effect of Alprostadil on preventing contrast-induced nephropathy for percutaneous coronary intervention (PCI) in diabetic patients, but the clinical efficacy is not consistent, so we conduct this study and therefore determine the dominant strategy for the treatment of PCI in diabetic patients based on the best evidence currently.Methods:An electronic database search was conducted in MEDLINE, Embase, Cochrane library, CBM, CNKI, VIP, and WanFang to retrieve randomized controlled trial (RCT) comparing Alprostadil versus hydration on preventing CIN for PCI in diabetic patients. Reference lists of relevant articles were also screened manually to retrieve additional ones. Two investigators independently assessed the eligibility of retrieved articles using predefined inclusion and exclusion criteria. All characteristics as well as outcome variables including incidence of CIN, blood urea nitrogen (BUN), cystatin C (CysC), glomerular filtration rate (GFR), serum creatinine (Scr), serum beta 2-microspheres (β2-MG) presented in each included study were extracted. Heterogeneity was thought to be significant when I2 > 50%. All of the meta-analytic procedures were performed by using Review Manager software, version 5.3.Results:Finally, data from 8 articles including 969 patients were included into this meta-analysis, among them, 487 patients in the experience group, and 482 patients in the control group. Meta analysis showed that the incidence of CIN in the experimental group was significantly lower than that in the control group (OR = 0.28,95%CI[0.18,0.42]). The incidence of adverse reactions in the experimental group was significantly lower than that in the control group (OR = 0.46,95%CI[0.24,0.85]). The BUN of 24 hours, 48 hours, and 72 hours in the experimental group were significantly lower than that of control group (MD = –0.77, 95%CI [−1.22, –0.32]; MD = –1.38, 95%CI [−1.83,–0.92]; MD = –2.43, 95%CI [−2.68,–2.19], respectively). The CysC of 24 hours, 48 hours, and 72 hours in the experimental group were significantly lower than that of control group (MD = –0.30, 95%CI [−0.40, –0.21]; MD = –0.54, 95%CI [−0.68,–0.41]; MD = –0.49, 95%CI [−0.63, –0.35], respectively). The GFR of 24 hours, 48 hours, and 72 hours in the experimental group were significantly higher than that of control group (MD = 7.86, 95%CI [4.44, 11.29], MD = 18.23, 95%CI [13.76,22.69], MD = 12.81, 95%CI [8.51,17.11], respectively). The Scr of 24 hours, 48 hours, and 72 hours in the experimental group were significantly lower than that of control group (MD = –9.09, 95%CI [−12.67, –5.51], MD = –19.14, 95%CI [−23.61, –14.66], MD = –6.50, 95%CI [−8.29, –4.71], respectively). The β2-MG of 24 hours, 48 hours, and 72 hours in the experimental group were significantly lower than that of control group (MD = –0.12, 95%CI [−0.27, 0.03], MD = –0.55, 95%CI [−0.71, –0.39], MD = –0.50, 95%CI [−0.60, –0.39], respectively).Conclusion:Our result suggested that comparing with conventional Hydration, Alpros...

Efficacy of alprostadil in preventing contrast‐induced nephropathy in patients undergoing percutaneous coronary intervention: A multicenter prospective randomized controlled trial

“…Zhang et al conducted a randomized controlled clinical trial involving 120 patients with coronary heart disease combined with diabetic mellitus undergoing coronary artery intervention therapy and indicated that alprostadil could significantly improve eGFR and effectively prevent the occurrence of CIN in such people. Similarly, in the diabetes mellitus subgroup analysis of the present study, it was also confirmed that the effect of alprostadil on the prevention of CIN was more beneficial in the patients with diabetes mellitus (OR = 0.26, 95% CI = 0.10–0.65, P = 0.003).A recently published meta‐analysis, involving 969 patients with diabetes mellitus undergoing PCI, also demonstrated that alprostadil could significantly decreased the incidence of CIN and adverse reactions . Therefore, alprostadil may become a promising candidate for prevention of CIN.…”

“…Koch et al [19] first explored the preventive effect of alprostadil on CIN in patients with renal impairment (SCr 1.5 mg/dl) and found that SCr in the alprostadil group was significantly lower than that in the placebo group after contrast administration. In our subgroup analysis, alprostadil showed a beneficial prophylactic effect in patients with eGFR 60 ml/ [20]. Therefore, alprostadil may become a promising candidate for prevention of CIN.…”

Post-contrast acute kidney injury. Part 2: risk stratification, role of hydration and other prophylactic measures, patients taking metformin and chronic dialysis patients

“…The data on the protective effects of several agents, such as trimatizidine [ 123 , 124 ], theophylline [ 95 , 125 – 127 ], alprostadil [ 128 , 129 ], nebivolol [ 130 ], fenoldopam [ 131 ] and iloprost [ 132 ], is not conclusive and does not support recommending their use to reduce the risk of PC-AKI.…”

Effects of remote ischemic preconditioning on contrast induced nephropathy after percutaneous coronary intervention in patients with acute coronary syndrome

“…Percutaneous coronary intervention (PCI) is the most effective means in the treatment of ACS in the world. [ 1 ] In recent years, with the development of clinical diagnosis and interventional therapy, the dose of contrast agent in PCI is increasing, and PCI can lead to contrast-induced nephropathy (CIN). Therefore, CIN has become a common complication of PCI, and has become the third leading cause of acute renal failure in hospital.…”