Trimetazidine reduces contrast-induced nephropathy in patients with renal insufficiency undergoing coronary angiography and angioplasty

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 m 2 ) 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 I 2 statistic, using a fixed-effects model, and >50% of I 2 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 I 2 = 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.

Efficacy of Trimetazidine in the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Contrast Coronary Intervention: A Systematic Review and Meta-Analysis (PRISMA)

“…Our results provide robust evidence adding to the previous systematic review and meta-analysis by Behzadi et al focusing on patients with renal insufficiency [2]. In contrast to this previous meta-analysis [2] that included a total of 1611 patients from 11 articles, our present analysis included robust data from 2158 patients from 9 articles published in the English language only within the last 15 years.…”

“…CIN may affect 1.6% to 2.3% of those undergoing diagnostic interventions but is known to affect up to half of the high-risk patients undergoing coronary intervention [2]. It is an important cause of hospital-acquired kidney injury, especially in those with risk factors such as hypertension, diabetes mellitus, previous myocardial infarction, higher age, damaged left anterior descending artery, Killip class of 2 or higher, lower left ventricular ejection fraction (LVEF), reduced glomerular filtration rate, etc.…”

“…A previous systematic review has assessed the published evidence on the efficacy of trimetazidine in the prevention of CIN in patients undergoing CAG or PCI. In this recent systematic review and meta-analysis [2], trimetazidine was associated with a reduced risk of CIN; however, the study was finalized in October 2020. Two major clinical trials evaluating the same research question have been published recently [4,9].…”

Perioperative acute kidney injury: impact and recent update

“…More research is needed to show the impact of N-acetylcysteine in reducing AKI [87]. Therapeutic interventions that have been shown to decrease CIAKI, in the catheterization lab setting, include hydration, the RenalGuard system [76], and trimetazidine [88], a fatty acid oxidation inhibitor with cardioprotective effects.…”

Preventive Effect of Shenduning Prescription Combined with Hydration Therapy on Contrast Induced Nephronpathy after Elective Percutaneous Coronary Intervention

“…However, the side effects caused by contrast agent during percutaneous coronary intervention cannot be ignored, especially the occurrence of contrast-induced nephropathy (CIN) , which significantly affects the prognosis of patients [1] . Studies have confirmed [1][2][3] that the incidence of CIN in the general population is 5.8%, but it is higher than 50% in some high-risk groups, which must be taken seriously by relevant personnel. However, the exact mechanism of CIN occurrence is still unknown, and it is generally accepted that it may have certain relationship with the renal medullary ischemia and hypoxia, renal damage caused by oxygen free radical, toxic effect of contrast agent and inflammatory reaction [4][5][6] .…”