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Nair T, Ray S, George J, Pande A. Efficacy of Trimetazidine in the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Contrast Coronary Intervention: A Systematic Review and Meta-Analysis (PRISMA). J Clin Med 2024; 13:2151. [PMID: 38610916 PMCID: PMC11012740 DOI: 10.3390/jcm13072151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/05/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Objective: The present systematic review assessed the efficacy of peri-procedurally administered trimetazidine in the prevention of contrast-induced nephropathy (CIN) in patients undergoing coronary interventions with contrast agents. Methods: We performed a systematic literature review of articles published in PubMed and Google Scholar by 7 December 2023 and included articles from the last 15 years that evaluated the efficacy of trimetazidine in preventing CIN in cardiac patients undergoing coronary intervention. Results: After title/abstract and full-text screening, this systematic review included 9 randomized controlled trials (N = 2158 patients) with two groups: Trimetazidine (60-70 mg/day 24 to 48 h before and up to 72 h after the procedure) with hydration and the control group with only hydration. A total of 234/2158 patients developed CIN (Incidence rate [IR], 10.8%) as per the CIN definition of the Contrast Media Safety Committee of the European Society of Urogenital Radiology. The incidence of CIN in the trimetazidine vs. control group was 6.4% (69/1083) vs. 15.4% (165/1075), and the odds ratio (95% CI) was 0.3753 (0.279-0.504). Conclusions: In conclusion, the trimetazidine group had a lower incidence of CIN. Trimetazidine offers a reno-protective effect and helps in reducing the CIN incidence in patients undergoing cardiac intervention. Peri-procedure administration of trimetazidine significantly decreases the risk of CIN in patients despite comorbidities.
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Affiliation(s)
- Tiny Nair
- Department of Cardiology, PRS Hospital, Thiruvananthapuram 695002, Kerala, India
| | - Saumitra Ray
- Invasive Cardiology, AMRI Hospital, Kolkata 700019, West Bengal, India;
| | - Jacob George
- Department of Nephrology, Trivandrum Medical College, Thiruvananthapuram 695011, Kerala, India;
| | - Arindam Pande
- Department of Cardiology, Medica Superspeciality Hospital, Kolkata 700099, West Bengal, India;
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2
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Gupta K, Pandey S, Bagang N, Mehra K, Singh G. Trimetazidine an emerging paradigm in renal therapeutics: Preclinical and clinical insights. Eur J Pharmacol 2021; 913:174624. [PMID: 34774496 DOI: 10.1016/j.ejphar.2021.174624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
Trimetazidine (TMZ) is a well-known anti-ischemic agent used for the treatment of angina pectoris. In the past decades, the efficacy of this drug has been tested in a wide range of kidney injuries, including drug-induced nephrotoxicity (DIN), radio-contrast agent-induced nephropathy, and surgically induced renal ischemic injury. TMZhas renoprotective effects by attenuating oxidative stress, inflammatory cytokine release, maintaining oxygen and energy balance. Moreover, TMZ administration prevented kidney graft rejection in the porcine model by suppressing the infiltration of mononuclear cells, preserving mitochondrial functions, and maintaining Ca+ homeostasis. In DIN and diabetic kidney diseases,TMZ treatment prevents renal injury by inactivating immune cells, attenuating renal fibrosis, inflammation, apoptosis, and histological abnormalities. Interestingly, the clinical therapeutic efficacy of TMZ has also been documented in pre-existing kidney disease patients undergoing contrast exposure for diagnostic intervention. However, the mechanistic insights into the TMZ mediated renoprotective effects in other forms of renal injuries, including type-2 diabetes, drug-induced nephrotoxicity, and hypertension-induced chronic kidney diseases, remain uninvestigated and incomplete. Moreover, the clinical utility of TMZ as a renoprotective agent in radio-contrast-induced nephrotoxicity needs to be tested in a large patient population. Nevertheless, the available pieces of evidence suggest that TMZ is a promising and emerging renal therapy for the treatment and management of kidney diseases of variable etiologies. This review discusses the various pre-clinical and clinical findings and provides mechanistic insights into the TMZ mediated beneficial effects in various kidney diseases.
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Affiliation(s)
- Kirti Gupta
- Department of Pharmacy, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala (Haryana), India
| | - Sneha Pandey
- Department of Pharmacology, Indo-Soviet Friendship College of Pharmacy, Moga, Punjab, India
| | - Newly Bagang
- Department of Pharmacology, Indo-Soviet Friendship College of Pharmacy, Moga, Punjab, India
| | - Kamalpreet Mehra
- Department of Pharmacy, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala (Haryana), India
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3
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Heshmatzadeh Behzadi A, Amoozgar B, Jain S, Velasco N, Zahid U, Abbasi H, Alasadi L, Prince MR. Trimetazidine reduces contrast-induced nephropathy in patients with renal insufficiency undergoing coronary angiography and angioplasty: A systematic review and meta-analysis (PRISMA). Medicine (Baltimore) 2021; 100:e24603. [PMID: 33725824 PMCID: PMC7969219 DOI: 10.1097/md.0000000000024603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/26/2020] [Accepted: 01/12/2021] [Indexed: 01/05/2023] Open
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.
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Affiliation(s)
| | - Behzad Amoozgar
- Department of Medicine, Jersey Shore University Medical Center, Perth Amboy Divisions, New Jersey
| | - Shalini Jain
- CHI Health Creighton University Medical Center, Omaha
| | - Noel Velasco
- Department of Radiology, Yale New Haven, Bridgeport Hospital, Connecticut
| | - Umar Zahid
- Brookdale University Hospital Medical Center, New York
| | - Hamidreza Abbasi
- Hackensack Meridian Health and JFK Neuroscience Institute, Edison, NJ
| | - Lutfi Alasadi
- Brookdale University Hospital Medical Center, New York
| | - Martin R. Prince
- Department of Radiology, Weill Cornell Medicine
- Department of Radiology, Columbia College of Physicians and Surgeons, New York
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4
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Wang C, Chen W, Yu M, Yang P. Efficacy of Trimetazidine in Limiting Periprocedural Myocardial Injury in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. Angiology 2021; 72:511-523. [PMID: 33472383 DOI: 10.1177/0003319720987745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We systematically searched the literature to assess the efficacy of trimetazidine in reducing periprocedural myocardial injury and improving postoperative left ventricular ejection fraction (LVEF) in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). An electronic search was conducted based on the PubMed, Ovid, Scopus, Springer, CENTRAL, and Google Scholar databases; 14 randomized controlled trials (RCTs) were included. Our meta-analysis showed a significant reduction in cardiac troponin I (cTnI) levels with trimetazidine compared with controls (P < .00001) but not in serum creatine kinase-myocardial band levels (P = .49). There were significantly reduced odds of ischemic ST-T segment changes with trimetazidine (P = .0.03) but lack of significant difference in the incidence of anginal attacks between the 2 groups (P = .10). Results also suggest significantly higher LVEF with trimetazidine compared with controls (P < .00001). Meta-regression analysis indicated no influence of duration of trimetazidine therapy on cTnI levels. The administration of preprocedure trimetazidine may have a role in reducing periprocedural myocardial injury in patients with CAD undergoing PCI. Evidence also suggests that postoperative trimetazidine may improve LVEF in the short term. Lack of high-quality trials and the heterogeneity of studies limit the ability of our analysis to draw strong conclusions. Further well-designed RCTs are required to supplement current evidence.
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Affiliation(s)
- Chang Wang
- Department of Cardiology, 74569China-Japan Union Hospital of Jilin University, Changchun, Jilin, P. R. China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Jilin, P. R. China.,Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Jilin, P. R. China
| | - Weiwei Chen
- Department of Cardiology, 74569China-Japan Union Hospital of Jilin University, Changchun, Jilin, P. R. China.,Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Jilin, P. R. China.,Jilin Provincial Cardiovascular Research Institute, Jilin, P. R. China
| | - Ming Yu
- Department of Cardiology, 74569China-Japan Union Hospital of Jilin University, Changchun, Jilin, P. R. China.,Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Jilin, P. R. China.,Jilin Provincial Cardiovascular Research Institute, Jilin, P. R. China
| | - Ping Yang
- Department of Cardiology, 74569China-Japan Union Hospital of Jilin University, Changchun, Jilin, P. R. China.,Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Jilin, P. R. China.,Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin, P. R. China
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5
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Fu H, Zhang J, Zhang H, Zhang P, Fu X, Zeng Z, Zhang X, Li W, Yang S, Liu X, Fu N. Trimetazidine can prevent the occurrence of contrast-induced nephropathy after percutaneous coronary intervention in elderly patients with renal insufficiency. Perfusion 2020; 36:603-609. [PMID: 32909511 DOI: 10.1177/0267659120957856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) has become a common cause of hospital-acquired acute kidney injury in elderly patients. Trimetazidine (TMZ) is a type of anti-ischemic drug developed in recent years, which can reduce the incidence of CIN. This study aimed to evaluate the efficacy of TMZ in the prevention of contrast-induced nephropathy in elderly patients with renal insufficiency undergoing percutaneous coronary intervention (PCI) and to explore the mechanism of action. METHODS A total of 310 elderly patients with renal insufficiency undergoing elective PCI were enrolled and randomly assigned to a control group (n = 155, hydration only) and a TMZ group (n = 155, 20 mg thrice daily orally 24 hours before and 72 hours after PCI). The primary endpoint of the study was the incidence of CIN, which was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dL or more in serum creatinine from baseline value, at 48 to 72 hours following the exposure to contrast media (CM). RESULTS The incidence of CIN was significantly lower in the TMZ group than that in the control group (3.2% vs. 9.7%, p = 0.021). There was no difference regarding the incidence of major adverse events during hospitalization between the TMZ group and control group (1.9% vs. 2.6%, p = 1.000). Binary logistic regression results showed that TMZ was protective factors of CIN (OR = 0.274; 95% CI: 0.089-0.847; p = 0.025). CONCLUSION Therefore, we came to the conclusion that prophylactic administration of TMZ can prevent the occurrence of CIN in elderly patients with renal insufficiency undergoing PCI and has a certain protective effect on the renal function of patients. According to the experimental results and the mechanism of TMZ on cardiomyocytes, we speculate that TMZ increases kidney glucose metabolism, reduces fatty acid oxidation, and also has a protective effect on kidney free radical damage and ischemia-reperfusion injury.
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Affiliation(s)
- Han Fu
- Tianjin Medical University, Tianjin, China
| | | | | | | | | | | | - Xue Zhang
- Tianjin Medical University, Tianjin, China
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6
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Zhang X, Zhang P, Yang S, Li W, Men X, Fu N. Preventive effect of trimetazidine on contrast-induced nephropathy undergoing percutaneous coronary intervention in elderly moderate and high risk diabetics stratified by mehran score. Perfusion 2020; 36:491-500. [PMID: 32838661 DOI: 10.1177/0267659120952057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this research was to use the Mehran risk score to classify elderly diabetics with coronary heart disease to assess the preventive effect of trimetazidine on contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in different risk population. METHODS An uncompromised of 760 elderly diabetics that went through PCI were included in this research. The patients were first divided into three groups in the light of MRS: low-risk, moderate-risk, and high-risk group, then randomized into trimetazidine group and the control group respectively. The first endpoint was the amount of CIN, which is described as a rise in serum creatinine levels by ⩾44.2 μmol/L or ⩾25% ratio within 48 or 72 hours after medication. Second endpoint included differences in creatinine clearance rate (CrCl), blood urea nitrogen (BUN), serum creatinine (Scr), cystatin-C (Cys-C), and the incidence of major adverse events after administration. RESULTS In the three groups, the incidence of CIN in trimetazidine and control group was 5.0% versus 4.9%(χ2 = 0.005, p > 0.05), 8.0% versus 18.0% (χ2 = 7.685, p < 0.05), 10.4% versus 27.1% (χ2 = 4.376, p < 0.05), respectively. The multivariable logistic regression result demonstrated that trimetazidine intervention was a profitable element of CIN in moderate and high-risk groups (OR = 0.294, 95% CI 0.094-0.920, p = 0.035). CONCLUSION Our study confirmed that trimetazidine can be considered for preventive treatment of CIN occurrence in elderly diabetics with moderate and high-risk population, while there is no obvious advantage compared with hydration therapy in low-risk patients.
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Affiliation(s)
- Xue Zhang
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Peng Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Shicheng Yang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Wenyuan Li
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Xiuzhen Men
- Department of Catheter lab, Dongying Second People's Hospital, Shandong,China
| | - Naikuan Fu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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7
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Toso A, Leoncini M, Maioli M, Bellandi F. Pharmacologic Prophylaxis of Contrast-Induced Nephropathy. Interv Cardiol Clin 2020; 9:369-383. [PMID: 32471677 DOI: 10.1016/j.iccl.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Different pharmacologic agents have been tested in the effort to prevent contrast-induced acute kidney injury (AKI) in the last two decades. To date, however, no individual drug has received unanimous approval for this aim. Since 2014 statins have been included as preventive treatment in the European guidelines for revascularization procedures in cardiac patients. The present update presents the latest findings in this field focusing on the changing paradigms in the definition and consequently the approach to nephroprotection that considers clinical prognosis as the major issue. We note the current shift from attention to contrast-induced AKI to contrast-associated AKI.
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Affiliation(s)
- Anna Toso
- Division of Cardiology, Santo Stefano Hospital, Via Suor Niccolina Infermiera, 20, Prato 59100, Italy.
| | - Mario Leoncini
- Division of Cardiology, Santo Stefano Hospital, Via Suor Niccolina Infermiera, 20, Prato 59100, Italy
| | - Mauro Maioli
- Division of Cardiology, Santo Stefano Hospital, Via Suor Niccolina Infermiera, 20, Prato 59100, Italy
| | - Francesco Bellandi
- Division of Cardiology, Santo Stefano Hospital, Via Suor Niccolina Infermiera, 20, Prato 59100, Italy
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8
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Li X, Zhang W, Liu J, Gonzalez L, Liu D, Zhang L, Dardik A, Shu C. Contrast-Induced Kidney Nephropathy in Thoracic Endovascular Aortic Repair: A 2-Year Retrospective Study in 470 Patients. Angiology 2019; 71:242-248. [PMID: 31829038 DOI: 10.1177/0003319719893578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We identified changes in renal function in patients who underwent thoracic endovascular aortic repair (TEVAR) and the factors that may influence renal function. Information on 470 consecutive patients was collected. Kidney function and contrast volume were recorded. Unpaired t test, Spearman correlation, and logistic regression were used for statistical analysis. A Kaplan-Meier curve helped clarify our follow-up findings. Mean contrast volume was 90.5 ± 21.2 mL. The change in serum creatinine was significantly correlated with (1) preexisting renal pathology (P = .033) and (2) aortic dissection (AD) involving the renal arteries (P = .019). The change in serum urea nitrogen (ΔBUN) was only significantly correlated with AD involving the renal arteries (P = .0348). Contrast volume (P = .036, odds ratio = 1.010, 95% confidence interval: 1.001-1.019) was a risk factor for contrast-induced nephropathy (CIN) after TEVAR. Survival rates and renal failure rates among no CIN, CIN, and CIN-acute kidney injury groups at longest 27 months follow-up were significantly different. Creatinine and BUN were generally elevated post-TEVAR. Contrast-induced nephropathy post-TEVAR may correlate with renal comorbidities and renal artery involvement. Contrast volume is risk factor for CIN after TEVAR. More attention needs to be paid to patient renal function during follow-up.
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Affiliation(s)
- Xin Li
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China
| | - Weichang Zhang
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China
| | - Jia Liu
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China.,Department of Surgery and the Interdepartmental Program in Vascular Biology & Therapeutics, Yale University School of Medicine, New Haven, CT, USA
| | - Luis Gonzalez
- Department of Surgery and the Interdepartmental Program in Vascular Biology & Therapeutics, Yale University School of Medicine, New Haven, CT, USA
| | - Dingxiao Liu
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China
| | - Lei Zhang
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China
| | - Alan Dardik
- Department of Surgery and the Interdepartmental Program in Vascular Biology & Therapeutics, Yale University School of Medicine, New Haven, CT, USA
| | - Chang Shu
- Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Vascular Disease Institute, Central South University, Changsha, Hunan, People's Republic of China.,State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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9
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Lian X, He W, Zhan H, Chen J, Tan N, He P, Liu Y. The effect of trimetazidine on preventing contrast-induced nephropathy after cardiac catheterization. Int Urol Nephrol 2019; 51:2267-2272. [PMID: 31641999 DOI: 10.1007/s11255-019-02308-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/03/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Xingji Lian
- Department of Nephrology, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510100, Guangzhou, Guangdong, China
| | - Wenfei He
- Department of Cardiology, The Second People's Hospital of Nanhai District, Guangdong Provincial People's Hospital's Nanhai Hospital, 528251, Foshan, China
| | - Huimin Zhan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510100, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510100, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510100, Guangzhou, China
| | - Pengcheng He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510100, Guangzhou, China.
| | - Yuanhui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510100, Guangzhou, China.
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10
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Sharp AJ, Patel N, Reeves BC, Angelini GD, Fiorentino F. Pharmacological interventions for the prevention of contrast-induced acute kidney injury in high-risk adult patients undergoing coronary angiography: a systematic review and meta-analysis of randomised controlled trials. Open Heart 2019; 6:e000864. [PMID: 30774964 PMCID: PMC6350720 DOI: 10.1136/openhrt-2018-000864] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/04/2018] [Accepted: 11/10/2018] [Indexed: 12/19/2022] Open
Abstract
Objective Quantify the efficacy of strategies to prevent contrast-induced acute kidney injury (CI-AKI) in high-risk patients undergoing coronary angiography (CAG) with or without percutaneous coronary intervention (PCI). Background CI-AKI remains a common problem. The renoprotective efficacy of existing pharmacological agents remains uncertain in high-risk populations. Methods Systematic review and meta-analysis of randomised controlled trials (RCTs) to compare different strategies versus hydration in patients with chronic kidney disease (CKD) undergoing CAG±PCI. Primary outcome was incident CI-AKI. Fixed-effects meta-analyses estimated ORs, 95% CIs and heterogeneity. Results Forty-eight RCTs were included. Seven pharmacological strategies were evaluated by multiple RCTs and 10 by one RCT each. These had varying risk of bias; >25% of trials were at high risk of performance bias. Five strategies significantly reduced the odds of CI-AKI: N-acetylcysteine (NAC) (27 trials, 5694 participants; OR=0.77, 95% CI 0.65 to 0.91, p=0.002, I2=36%), ascorbic acid (four trials, 759 participants; OR=0.59, 95% CI 0.39 to 0.89, p=0.01, I2=0%), statin (two trials, 3234 participants; OR=0.59, 95% CI 0.39 to 0.89, p=0.75, I2=0%), trimetazidine (two trials, 214 participants; OR=0.27, 95% CI 0.10 to 0.71, p=0.01, I2=0%) and nicorandil (two trials, 389 participants; OR=0.47, 95% CI 0.23 to 0.94, p=0.03, I2=52%). Theophylline had a similar, but non-significant, effect. A subgroup analysis found that the benefit of NAC was highest in patients requiring a high-contrast dose. Conclusions Several drugs are renoprotective in patients with CKD undergoing CAG±PCI. The evidence is strongest for NAC. We recommend that NAC should be used when a high dose of contrast is anticipated. Trial registration number PROSPERO registration CRD42014014704. Open Science Framework link: https://osf.io/vxg7d/?view_only=62bad0404b18405abd39ff2ead2575a8
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Affiliation(s)
| | | | - Barney C Reeves
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Gianni D Angelini
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Francesca Fiorentino
- Imperial College Trial Unit and Division of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
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11
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Zhang W, Wu K, Lin H, Zhang J, Chen S. Effect of Trimetazidine on Preventing Contrast-Induced Acute Kidney Injury in Patients With Diabetes. Am J Med Sci 2018; 356:576-577. [PMID: 30180939 DOI: 10.1016/j.amjms.2018.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/28/2018] [Accepted: 06/08/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Weidai Zhang
- Department of Nephrology and; Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China; Department of Cardiology, Shantou Central Hospital, Shantou, Guangdong, China
| | | | | | - Jiawei Zhang
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Songming Chen
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
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12
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Ahmed K, McVeigh T, Cerneviciute R, Mohamed S, Tubassam M, Karim M, Walsh S. Effectiveness of contrast-associated acute kidney injury prevention methods; a systematic review and network meta-analysis. BMC Nephrol 2018; 19:323. [PMID: 30424723 PMCID: PMC6234687 DOI: 10.1186/s12882-018-1113-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 10/22/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Different methods to prevent contrast-associated acute kidney injury (CA-AKI) have been proposed in recent years. We performed a mixed treatment comparison to evaluate and rank suggested interventions. METHODS A comprehensive Systematic review and a Bayesian network meta-analysis of randomised controlled trials was completed. Results were tabulated and graphically represented using a network diagram; forest plots and league tables were shown to rank treatments by the surface under the cumulative ranking curve (SUCRA). A stacked bar chart rankogram was generated. We performed main analysis with 200 RCTs and three analyses according to contrast media and high or normal baseline renal profile that includes 173, 112 & 60 RCTs respectively. RESULTS We have included 200 trials with 42,273 patients and 44 interventions. The primary outcome was CI-AKI, defined as ≥25% relative increase or ≥ 0.5 mg/dl increase from baseline creatinine one to 5 days post contrast exposure. The top ranked interventions through different analyses were Allopurinol, Prostaglandin E1 (PGE1) & Oxygen (0.9647, 0.7809 & 0.7527 in the main analysis). Comparatively, reference treatment intravenous hydration was ranked lower but better than Placebo (0.3124 VS 0.2694 in the main analysis). CONCLUSION Multiple CA-AKI preventive interventions have been tested in RCTs. This network evaluates data for all the explored options. The results suggest that some options (particularly allopurinol, PGE1 & Oxygen) deserve further evaluation in a larger well-designed RCTs.
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Affiliation(s)
- Khalid Ahmed
- Lambe Institute for Translational Research, Discipline of Surgery National University of Ireland, Galway, Republic of Ireland. .,Department of Vascular surgery, Galway University Hospital, Galway, Republic of Ireland.
| | - Terri McVeigh
- Lambe Institute for Translational Research, Discipline of Surgery National University of Ireland, Galway, Republic of Ireland
| | - Raminta Cerneviciute
- Lambe Institute for Translational Research, Discipline of Surgery National University of Ireland, Galway, Republic of Ireland
| | - Sara Mohamed
- Lambe Institute for Translational Research, Discipline of Surgery National University of Ireland, Galway, Republic of Ireland
| | - Mohammad Tubassam
- Department of Vascular surgery, Galway University Hospital, Galway, Republic of Ireland
| | - Mohammad Karim
- School of Population and Public Health, University of British Columbia, Scientist / Biostatistician, Centre for Health Evaluation and Outcome Sciences (CHEOS), St. Paul's Hospital, Vancouver, Canada
| | - Stewart Walsh
- Lambe Institute for Translational Research, Discipline of Surgery National University of Ireland, Galway, Republic of Ireland.,Department of Vascular surgery, Galway University Hospital, Galway, Republic of Ireland.,HRB Clinical Research Facility Galway, Galway, Republic of Ireland
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Kallistratos MS, Poulimenos LE, Giannitsi S, Tsinivizov P, Manolis AJ. Trimetazidine in the Prevention of Tissue Ischemic Conditions. Angiology 2018; 70:291-298. [PMID: 29888611 DOI: 10.1177/0003319718780551] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Trimetazidine (TMZ) is a metabolic agent with significant anti-ischemic properties. By inhibiting the terminal enzyme in the β-oxidation pathway, it shifts the energy substrate metabolism, enhancing glucose metabolism. Thus, it maintains the required energy production with less oxygen consumption, an effect necessary in cases of myocardi. Trimetazidine was recently reaccredited as add-on therapy for symptomatic treatment in patients with stable angina, not adequately controlled or intolerant to first-line therapy. Trimetazidine was included in the European Society of Cardioloy 2013 guidelines for the management of stable coronary artery disease. Although TMZ has been used in cardiology for >40 years, only a few studies have assessed its effects in patients with acute ischemic conditions. This review summarizes the current literature regarding the addition of TMZ in patients with acute ischemic conditions (acute myocardial infarction, ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting). There is growing evidence from recent studies that the addition of TMZ in patients with such conditions is beneficial in terms of myocardial damage and major cardiac events as well as decreasing reperfusion injury and contrast-induced nephropathy.
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Affiliation(s)
| | | | - Sofia Giannitsi
- 1 Cardiology Department, Asklepieion General Hospital, Athens, Greece
| | - Pavlos Tsinivizov
- 1 Cardiology Department, Asklepieion General Hospital, Athens, Greece
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Valappil SP, Kunjukrishnapillai S, Viswanathan S, Koshy AG, Gupta PN, Velayudhan RV, Iype M. Remote ischemic preconditioning for prevention of contrast induced nephropathy-Insights from an Indian study. Indian Heart J 2017; 70:857-863. [PMID: 30580857 PMCID: PMC6306307 DOI: 10.1016/j.ihj.2017.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/26/2017] [Accepted: 11/15/2017] [Indexed: 01/18/2023] Open
Abstract
Objectives To study if four cycles of remote ischemic preconditioning (RIPC) could offer protection against contrast induced nephropathy (CIN) and post procedural renal dysfunction in high risk patients undergoing percutaneous coronary intervention (PCI). Methods This was a prospective single blind randomized sham controlled trial where patients undergoing coronary angioplasty with stage III chronic kidney disease were randomized into sham preconditioning and remote ischemic preconditioning. The primary outcome was the reduction in the incidence of CIN. The secondary outcomes were the maximum improvement in eGFR, maximum reduction in serum creatinine and composite of requirement of hemodialysis, death and rehospitalization for heart failure up to 6 weeks after PCI. Results Eleven out of fifty patients in the study group developed CIN (22%) compared to eighteen out of the fifty control patients (36%) (p = 0.123). There was a statistically significant improvement in the post procedure creatinine values at 24 h (p = 0.013), 48 h (p = 0.015), 2 weeks (p = 0.003), 6 weeks (p = 0.003) and post procedure glomerular filtration rate (eGFR) values at 24 h (p = 0.026), 48 h (p = 0.044), 2 weeks (p = 0.015) and 6 weeks (p = 0.011) in study group compared to control group. The secondary outcome composite of requirement of hemodialysis, death and rehospitalization for heart failure was not statistically significant (p: 0.646). Conclusion RIPC does not result in significant reduction of CIN. However RIPC helps in the prevention of post procedural worsening in eGFR and serum creatinine even up to 6 weeks.
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Affiliation(s)
- Sanjai Pattu Valappil
- Department of Cardiology, Government Medical College, Thiruvananthapuram, Kerala 695011, India.
| | | | - Sunitha Viswanathan
- Department of Cardiology, Government Medical College, Thiruvananthapuram, Kerala 695011, India
| | | | - Prabha Nini Gupta
- Department of Cardiology, Government Medical College, Thiruvananthapuram, Kerala 695011, India
| | | | - Mathew Iype
- Department of Cardiology, Government Medical College, Thiruvananthapuram, Kerala 695011, India
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Ghelich Khan Z, Talasaz AH, Pourhosseini H, Hosseini K, Alemzadeh Ansari MJ, Jalali A. Potential Role of Allopurinol in Preventing Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention: A Randomized Placebo-Controlled Trial. Clin Drug Investig 2017; 37:853-860. [DOI: 10.1007/s40261-017-0542-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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16
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Zou H, Zhu XX, Ding YH, Jin QY, Qian LY, Huang DS, Cen XJ. Trimetazidine in conditions other than coronary disease, old drug, new tricks? Int J Cardiol 2017; 234:1-6. [DOI: 10.1016/j.ijcard.2017.02.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 01/06/2017] [Accepted: 02/20/2017] [Indexed: 12/14/2022]
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17
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Ye Z, Lu H, Su Q, Guo W, Dai W, Li H, Yang H, Li L. Clinical effect of trimetazidine on prevention of contrast-induced nephropathy in patients with renal insufficiency: An updated systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e6059. [PMID: 28248861 PMCID: PMC5340434 DOI: 10.1097/md.0000000000006059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND With the continuous development of cardiac interventional medicine, the incidence of contrast-induced nephropathy (CIN) is increasing every year, which is a serious threat to people's physical and mental health. Trimetazidine (TMZ) is a type of anti-ischemic drug developed in recent years, which can significantly reduce the incidence of CIN. At present, a systematic review and meta-analysis was conducted to evaluate the clinical effect of TMZ on prevention of CIN in patients with renal insufficiency. However, the study did not include patients from other countries and speaking different languages. So we conducted this study to update the previous meta-analysis that investigated the effects of TMZ on prevention of CIN in patients with renal insufficiency, and provided some theoretical reference for clinical. METHODS By searching PubMed, Embase, the Cochrane Library, Web of Science, CBM, CNKI, VIP database, and Wang Fang database for randomized controlled trial, which is comparing TMZ versus conventional hydration for prevention of CIN. Two researchers independently screened literature, and then evaluated the quality of literature and extracted the relevant data. Stata 11.0 software was used for statistical analysis. RESULTS Finally, this updated review showed that 3 studies that were not included in the previous meta-analysis were included in our study (3 articles were published in the Chinese Journal, 1 study for CIN, 1 study for CIN, serum creatinine (Scr), and superoxide dismutase, 1 study for CIN and Scr), and 1 outcome (Scr) reflecting the change of renal function was additionally included in our study. Of the 932 studies, 6 randomized controlled trials met the criteria, including 377 patients in TMZ group and 387 patients in control group. This meta-analysis for all studies showed that TMZ can significantly reduce the incidence of CIN (relative risk 0.27, 95% confidence interval [CI] 0.16, 0.46, P = 0.000), and can decrease the level of Scr after operation, including Scr of postoperative 24 hours (standardized mean difference [SMD] -0.30, 95% CI -0.51, -0.09, P = 0.005), Scr of postoperative 48 hours (SMD -0.66, 95% CI -1.23, -0.10, P = 0.022), and Scr of postoperative 7 days (SMD -0.74, 95% CI -1.36, -0.11, P = 0.021). However, the Scr of postoperative 72 hours between TMZ group and control group has no statistical significance (P = 0.362). CONCLUSION Our study showed that when comparing with conventional hydration, TMZ can significantly reduce the incidence of CIN and the level of postoperative Scr. Therefore, we could suggest that TMZ was superior to conventional hydration for the treatment of CIN in patients with renal insufficiency. However, due to the restriction of quality and number of included articles, it still needs to carry out multicenter, randomized, double-blind clinical trials to confirm this conclusion in the future.
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Affiliation(s)
- Ziliang Ye
- Department of Cardiology, the First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute
| | - Haili Lu
- Department of Cardiology, the First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute
| | - Qiang Su
- Department of Cardiology, the First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute
| | - Wenqin Guo
- Department of Cardiology, the First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute
| | - Weiran Dai
- Department of Cardiology, the First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute
| | - Hongqing Li
- Department of orthodontic, the Affiliated Dental Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Huafeng Yang
- Department of Cardiology, the First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute
| | - Lang Li
- Department of Cardiology, the First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute
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Turedi S, Erdem E, Karaca Y, Tatli O, Sahin A, Turkmen S, Gunduz A. The High Risk of Contrast-induced Nephropathy in Patients with Suspected Pulmonary Embolism Despite Three Different Prophylaxis: A Randomized Controlled Trial. Acad Emerg Med 2016; 23:1136-1145. [PMID: 27411777 DOI: 10.1111/acem.13051] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/15/2016] [Accepted: 06/05/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective was to compare the protective effects of N-acetylcysteine (NAC) plus normal saline (NS), sodium bicarbonate (NaHCO3 ) plus NS, and NS alone in the prevention of contrast-induced nephropathy (CIN) after computed tomography pulmonary angiography (CTPA) in emergency patients. METHODS This study was planned as a randomized, controlled clinical research. Patients undergoing contrast-enhanced CTPA on suspicion of pulmonary embolism (PE) in the emergency department and with at least one risk factor for development of CIN were included in one of three different prophylaxis groups. The groups received 3 mL/kg intravenous (IV) NAC+NS or NaHCO3 +NS solution or NS alone 1 hour before CTPA and 1 mL/kg IV per hour for a minimum of 6 hours after CTPA. CIN was evaluated as the primary outcome and moderate or severe renal insufficiency and in-hospital mortality as secondary outcomes. RESULTS A total of 257 patients were enrolled in the study. The total level of CIN development was 23.7% (61/257), the level of moderate and severe renal failure was 12.5% (32/257), and the in-hospital mortality rate was 12.8% (33/257). Rates of CIN development in the drug groups were 23.5% in the NAC group (20/85), 21.2% (18/85) in the NaHCO3 group, and 26.4% in the NS group (23/87). Rates of development of moderate or severe renal insufficiency were 9.4% in the NAC group (8/85), 10.6% in the NaHCO3 group (9/85), and 17.2% in the NS group (15/87). In-hospital mortality rates were 12.9% in the NAC group (11/85), 11.8% in the NaHCO3 group (10/85), and 13.8% in the NS group (12/87). No difference was determined between the drug groups in terms of CIN, moderate or severe renal injury, or hospital mortality. CONCLUSIONS Our results indicate that there is a high risk of CIN in patients with suspected PE despite three different types of prophylaxis being administered, and no statistically significant differences were observed among prophylactic NAC, NaHCO3 , and NS in prevention of CIN following contrast-enhanced CTPA.
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Affiliation(s)
- Suleyman Turedi
- Department of Emergency Medicine Faculty of Medicine Karadeniz Technical University Trabzon Turkey
| | - Erkan Erdem
- Department of Emergency Medicine Faculty of Medicine Karadeniz Technical University Trabzon Turkey
| | - Yunus Karaca
- Department of Emergency Medicine Faculty of Medicine Karadeniz Technical University Trabzon Turkey
| | - Ozgur Tatli
- Department of Emergency Medicine Faculty of Medicine Karadeniz Technical University Trabzon Turkey
| | - Aynur Sahin
- Department of Emergency Medicine Faculty of Medicine Karadeniz Technical University Trabzon Turkey
| | - Suha Turkmen
- Department of Emergency Medicine Faculty of Medicine Karadeniz Technical University Trabzon Turkey
| | - Abdulkadir Gunduz
- Department of Emergency Medicine Faculty of Medicine Karadeniz Technical University Trabzon Turkey
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