Trimetazidine in the prevention of contrast-induced nephropathy in chronic kidney disease

Ibrahim, T.; El-Mawardy, Ramzy H.; Elserafy, Ahmed Shawky; Elfekky, Ehab Mohamed

doi:10.1016/j.carrev.2017.02.006

Cited by 25 publications

(24 citation statements)

References 25 publications

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“…This denotes the possibility of reaching a peak elevation of Scr before 72 h. Moreover, Onbasili et al in their study, showed significantly reduced incidence of CIN on measuring Scr 48 h after contrast exposure in patients with pre-existing chronic kidney disease who received trimetazidine before contrast exposure [ 11 ].However, a study of Lian et al failed to show a reduction in CIN in patients who received trimetazidine group (529 patients) versus the control group (1625 patients) taking into consideration that they used trimetazidine 20 mg three times per day starting 24 h before angiography [ 12 ]. Ibrahim et al in their study, added trimetazidine 35 mg twice daily 72 h before coronary angiography to isotonic saline hydration versus isotonic saline hydration only in patients with CrCl less than 90 ml/min undergoing elective coronary angiography and it showed a reduced incidence of CIN in trimetazidine group [ 13 ]. These data suggest that trimetazidine may be beneficial in reducing CIN if given in the dose of 35 mg twice 48 h especially in patients with chronic kidney disease undergoing elective angiography.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, Iranirad et al on their study (140 patients) reported that in patients with at least 2 risk factors for CIN undergoing coronary angiography, allopurinol failed to show significant reduction in CIN [ 16 ]. The increased amount of contrast media was associated with an increased incidence of CIN and it is strongly recommended to minimize the volume of contrast media used [ 9 ].In comparison to other studies we did not show a significant reduction in CIN on measuring Scr and CrCl 72 h following contast exposure after using trimetazidine or allopurinol 48 h before angiography in addition to adequate hydration, but this study may point to the importance of measuring Scr and CrCl 48 h not 72 h after contrast exposure to avoid missing of CrCl decline and Scr rise and also may show that adequate hydration in patients not in high risk for development of CIN may be satisfactory as the benefit of pharmacological measures in addition to adequate hydration was seen in high risk patients as in the presence of pre-existing kidney disease [ 10 , 13 ]. Although contrast induced nephropathy occurred in 30 patients in our study (25%) all of them were managed conservatively by nephrologists and renal replacement therapy was not needed.…”

Section: Discussionmentioning

confidence: 99%

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Comparing Trimetazidine with Allopurinol in Prevention of Contrast Induced Nephropathy After Coronary Angiography

Galal¹,

Shehta²,

Attia³

et al. 2020

Journal of the Saudi Heart Association

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Objectives: Contrast-induced nephropathy is considered a serious complication following coronary angiography increasing morbidity and mortality. Various drugs have been assessed to reduce the incidence of contrast-induced nephropathy. In this study, we compared trimetazidine and allopurinol as a pharmacological measure to reduce the incidence of contrast-induced nephropathy. Methods: One hundred and twenty patients undergoing coronary angiography with baseline creatinine clearance more than 30 ml/minute were divided into three groups, 40 patients each. Group 1 received standard parenteral intravenous hydration in the form of isotonic saline at a rate of 1 ml/kg body weight per hour started 12 hours before angiography and up to 12 hours after the procedure. Group 2 received trimetazidine 35 mg twice per day for 72 hours starting 48 hours before the procedure in addition to intravenous hydration. Group 3 received allopurinol 300 mg once daily for 72 hours starting 48 hours before the procedure in addition to intravenous hydration. Serum creatinine and creatinine clearance were measured before and 72 hours after the procedure in addition to the volume of contrast media used. Results: Trimetazidine and allopurinol failed to reduce contrast-induced nephropathy significantly. Among patients with contrast-induced nephropathy volume of contrast media was significantly higher. Conclusion: Adding trimetazidine or allopurinol in addition to regular intravenous hydration with isotonic saline without targeting selectively high-risk patients did not reduce contrast-induced nephropathy following coronary angiography

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparing Trimetazidine with Allopurinol in Prevention of Contrast Induced Nephropathy After Coronary Angiography

Galal¹,

Shehta²,

Attia³

et al. 2020

Journal of the Saudi Heart Association

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“…Oxygen-free radical release leading to medullary ischemic injury is a major pathophysiology of CIN. Considering the antioxidant properties and cytoprotective effects of TMZ, several studies have evaluated the effect of TMZ on preventing CIN in patients with CKD undergoing PCI and obtained favorable results [9][10][11][12][13]. However, previous studies had no enough sample sizes and were restricted to only patients with CKD.…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

The effect of trimetazidine on preventing contrast-induced nephropathy after cardiac catheterization

Lian

Zhan

et al. 2019

Int Urol Nephrol

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Purpose Trimetazidine has been shown to prevent the risk of contrast-induced nephropathy (CIN) in patients with renal dysfunction undergoing percutaneous coronary intervention (PCI). However, the effect of trimetazidine on CIN in unselected patients is unknown. We aimed to evaluate the effect of trimetazidine on preventing CIN in unselected patients treated with PCI. Methods 2154 consecutive patients were enrolled and divided into the trimetazidine (n = 529) and non-trimetazidine group (n = 1625). Patients in the trimetazidine group received trimetazidine 20 mg thrice daily starting at least 24 h before the procedure and continuing until discharge. The primary outcome was CIN. Results CIN was observed in 197 (9.2%) patients. The incidence of CIN was similar between two groups (9.1% vs. 9.2%, P = 0.947). After adjusting for other potential risk factors, trimetazidine did not significantly reduce the risk of CIN (OR = 0.70, 95% CI 0.46-1.08, P = 0.104). The results remained similar when using the alternate definitions of CIN and different subgroup analysis based on diabetes or chronic kidney disease. In additional, no significant difference between two groups was found with respect to in-hospital major adverse clinical events (1.89% vs. 1.66%, P > 0.05). Conclusions Trimetazidine did not exert significant renal protective effect on preventing CIN and in hosptial major adverse clinical events in unselected patients undergoing PCI.

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“…Trimetazidine finally was developed as anticancer agent. A more recent study from 2017 [ 47 ] compared the additional (+hydration) administration of the drug with hydration alone and found lower CIN incidences: 10 versus 26%. Nevertheless, the mean contrast media volume was higher in CIN patients.…”

Section: Other Drugsmentioning

confidence: 99%

Contrast-Induced Nephropathy: Update on the Use of Crystalloids and Pharmacological Measures

Patschan

Buschmann

Ritter

2018

International Journal of Nephrology

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Contrast-induced nephropathy (CIN) is a frequent and severe complication in subjects receiving iodinated contrast media for diagnostic or therapeutic purposes. Several preventive strategies were evaluated in the past. Recent clinical studies and meta-analyses delivered some new aspects on preventive measures used in the past and present. We will discuss all pharmacological and nonpharmacological procedures. Finally, we will suggest individualized recommendations for CIN prevention.

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Trimetazidine in the prevention of contrast-induced nephropathy in chronic kidney disease

Cited by 25 publications

References 25 publications

Comparing Trimetazidine with Allopurinol in Prevention of Contrast Induced Nephropathy After Coronary Angiography

Comparing Trimetazidine with Allopurinol in Prevention of Contrast Induced Nephropathy After Coronary Angiography

The effect of trimetazidine on preventing contrast-induced nephropathy after cardiac catheterization

Contrast-Induced Nephropathy: Update on the Use of Crystalloids and Pharmacological Measures

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