Daniele Giacoppo1, Giuseppe Gargiulo1, Sergio Buccheri1, Patrizia Aruta1, Robert A Byrne1, Salvatore Cassese1, George Dangas1, Adnan Kastrati1, Roxana Mehran1, Corrado Tamburino1, Davide Capodanno2. 1. From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.). 2. From the Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy (D.G., G.G., S.B., C.T., D.C.); Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Germany (D.G., R.A.B., S.C., A.K.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy (P.A.); Interventional Cardiology Clinical Trials and Research, Icahn School of Medicine, Mount Sinai, New York, NY (G.D., R.M.); and DZHK (German Centre for Cardiovascular Research), Partner site Munich Heart Alliance, Germany (A.K.). dcapodanno@gmail.com.
Abstract
BACKGROUND: The effectiveness of currently available effective preventive strategies for contrast-induced acute kidney injury (CIAKI) is a matter of debate. METHODS AND RESULTS: We performed a Bayesian random-effects network meta-analysis of 124 trials (28 240 patients) comparing a total of 10 strategies: saline, statin, N-acetylcysteine (NAC), sodium bicarbonate (NaHCO3), NAC+NaHCO3, ascorbic acid, xanthine, dopaminergic agent, peripheral ischemic preconditioning, and natriuretic peptide. Compared with saline, the risk of CIAKI was reduced by using statin (odds ratio [OR], 0.42; 95% credible interval [CrI], 0.26-0.67), xanthine (OR, 0.32; 95% CrI, 0.17-0.57), ischemic preconditioning (OR, 0.48; 95% CrI, 0.26-0.87), NAC+NaHCO3 (OR, 0.50; 95% CrI, 0.33-0.76), NAC (OR, 0.68; 95% CrI, 0.55-0.84), and NaHCO3 (OR, 0.66; 95% CrI, 0.47-0.90). The benefit of statin therapy was consistent across multiple sensitivity analyses, whereas the efficacy of all the other strategies was questioned by restricting the analysis to high-quality trials. Overall, high heterogeneity was observed for comparisons involving xanthine and ischemic preconditioning, although the impact of NAC and xanthine was probably influenced by publication bias/small-study effect. Hydration alone was the least effective preventive strategy for CIAKI. Meta-regressions did not reveal significant associations with baseline creatinine and contrast volume. In patients with diabetes mellitus, no strategy was found to reduce the incidence of CIAKI. CONCLUSIONS: In patients undergoing percutaneous coronary procedures, statin administration is associated with a marked and consistent reduction in the risk of CIAKI compared with saline. Although xanthine, NAC, NaHCO3, NAC+NaHCO3, ischemic preconditioning, and natriuretic peptide may have nephroprotective effects, these results were not consistent across multiple sensitivity analyses.
BACKGROUND: The effectiveness of currently available effective preventive strategies for contrast-induced acute kidney injury (CIAKI) is a matter of debate. METHODS AND RESULTS: We performed a Bayesian random-effects network meta-analysis of 124 trials (28 240 patients) comparing a total of 10 strategies: saline, statin, N-acetylcysteine (NAC), sodium bicarbonate (NaHCO3), NAC+NaHCO3, ascorbic acid, xanthine, dopaminergic agent, peripheral ischemic preconditioning, and natriuretic peptide. Compared with saline, the risk of CIAKI was reduced by using statin (odds ratio [OR], 0.42; 95% credible interval [CrI], 0.26-0.67), xanthine (OR, 0.32; 95% CrI, 0.17-0.57), ischemic preconditioning (OR, 0.48; 95% CrI, 0.26-0.87), NAC+NaHCO3 (OR, 0.50; 95% CrI, 0.33-0.76), NAC (OR, 0.68; 95% CrI, 0.55-0.84), and NaHCO3 (OR, 0.66; 95% CrI, 0.47-0.90). The benefit of statin therapy was consistent across multiple sensitivity analyses, whereas the efficacy of all the other strategies was questioned by restricting the analysis to high-quality trials. Overall, high heterogeneity was observed for comparisons involving xanthine and ischemic preconditioning, although the impact of NAC and xanthine was probably influenced by publication bias/small-study effect. Hydration alone was the least effective preventive strategy for CIAKI. Meta-regressions did not reveal significant associations with baseline creatinine and contrast volume. In patients with diabetes mellitus, no strategy was found to reduce the incidence of CIAKI. CONCLUSIONS: In patients undergoing percutaneous coronary procedures, statin administration is associated with a marked and consistent reduction in the risk of CIAKI compared with saline. Although xanthine, NAC, NaHCO3, NAC+NaHCO3, ischemic preconditioning, and natriuretic peptide may have nephroprotective effects, these results were not consistent across multiple sensitivity analyses.
Authors: Alessandro Caracciolo; Renato Francesco Maria Scalise; Fabrizio Ceresa; Gianluca Bagnato; Antonio Giovanni Versace; Roberto Licordari; Silvia Perfetti; Francesca Lofrumento; Natasha Irrera; Domenico Santoro; Francesco Patanè; Gianluca Di Bella; Francesco Costa; Antonio Micari Journal: J Clin Med Date: 2022-04-23 Impact factor: 4.964
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