Efficacy of different pharmacological interventions in the prevention of contrast-induced acute kidney injury after percutaneous coronary intervention: an overview of systematic reviews_Chinese Journal of Evidence-Based Medicine

Authors：

LIANG Shichu ¹ , ZHANG Jing ¹ , LI Jing ² , MA Min ¹ , CHEN Zhonglan ¹ , HE Yong ¹ ,  HUANG He ¹

1. Department of Cardiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Research Center of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

HUANG He, Email: huanghe@wchscu.cn

Keywords：

Contrast-induced acute kidney injury; Coronary heart disease; Percutaneous coronary intervention; Overviews of systematic reviews

DOI：

10.7507/1672-2531.202112124

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To analyze systematic reviews (SRs) and meta-analyses on the efficacy of pharmacological interventions in the prevention of contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). Methods We searched the PubMed, The Cochrane Library, EMbase, CNKI, CBM, WanFang Data, and VIP databases to identify SRs and meta-analyses on the pharmacological interventions aimed at preventing CI-AKI after PCI from inception of the databases to February 2022. Two researchers independently screened the literature and extracted data. The PRISMA statement, AMSTAR 2 tool, and GRADE system were adopted to evaluate the reporting quality, methodological quality, and evidence quality of the findings of the included SRs and meta-analyses. Results A total of 14 SRs and meta-analyses were identified. Among the drugs used were statins, N-acetylcysteine, sodium bicarbonate, Dan-hong injection, vitamins, salvianolate, adenosine antagonists, nicorandil, allopurinol, alprostadil, furosemide, trimetazidine, probucol, and brain natriuretic peptide. Most of the studies had relatively comprehensive coverage of the items, with the PRISMA scores ranging from 18 to 24.5. The main issues of reporting quality were protocol and registration, search, and funding. The methodological quality of the SRs and meta-analyses was generally low. Items 2 and 7 were the key items with poor scores, and the non-critical items with poor scores were items 3, 10, and 16. All drugs, except furosemide, decreased the incidence of CI-AKI. The quality of evidence ranged from medium to very low according to GRADE. Conclusion Most of the single drugs or drugs combined with hydration show the potential to prevent CI-AKI, however, the overall methodological quality of the included studies is relatively low, and the strength of evidence is generally low.

Citation： LIANG Shichu, ZHANG Jing, LI Jing, MA Min, CHEN Zhonglan, HE Yong, HUANG He. Efficacy of different pharmacological interventions in the prevention of contrast-induced acute kidney injury after percutaneous coronary intervention: an overview of systematic reviews. Chinese Journal of Evidence-Based Medicine, 2022, 22(5): 575-584. doi: 10.7507/1672-2531.202112124 Copy

1.	Virani SS, Alonso A, Aparicio HJ, et al. Heart disease and stroke statistics-2021 update: a report from the American Heart Association. Circulation, 2021, 143(8): e254-e743.
2.	中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2020概要. 中国循环杂志, 2021, 36(6): 521-545.
3.	中华医学会心血管病学分会介入心脏病学组, 中华医学会心血管病学分会大血管病学组, 中华心血管病杂志编辑委员会. 经动脉心血管介入诊治中含碘对比剂相关不良反应防治的中国专家共识(2021). 中华心血管病杂志, 2021, 49(10): 972-985.
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5.	Bei W, Li H, Lin K, et al. Post-Hoc Study: intravenous hydration treatment in Chinese patients with high risk of contrast-induced nephropathy following percutaneous coronary intervention. Sci Rep, 2017, 7: 45023.
6.	Su X, Xie X, Liu L, et al. Comparative effectiveness of 12 treatment strategies for preventing contrast-induced acute kidney injury: a systematic review and Bayesian network meta-analysis. Am J Kidney Dis, 2017, 69(1): 69-77.
7.	Giacoppo D, Gargiulo G, Buccheri S, et al. Preventive strategies for contrast-induced acute kidney injury in patients undergoing percutaneous coronary procedures: evidence from a hierarchical Bayesian network meta-analysis of 124 trials and 28 240 patients. Circ Cardiovasc Interv, 2017, 10(5): e004383.
8.	中华医学会放射学分会质量控制与安全管理专业委员会. 肾病患者静脉注射碘对比剂应用专家共识. 中华放射学杂志, 2021, 55(6): 580-590.
9.	高洪阳, 赵阳, 高蕊, 等. Cochrane Overview的研究现状及制作方法调查. 中国循证医学杂志, 2014, 14(12): 1514-1519.
10.	Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ, 2009, 339: b2535.
11.	王靖, 刘琴, 翁淳光, 等. 国内公共卫生研究领域系统评价/Meta分析的质量评价. 中国循证医学杂志, 2010, 10(12): 1367-1374.
12.	Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
13.	张方圆, 沈傲梅, 曾宪涛, 等. 系统评价方法学质量评价工具AMSTAR 2解读. 中国循证心血管医学杂志, 2018, 10(1): 14-18.
14.	陈耀龙, 姚亮, Susan Norris, 等. GRADE在系统评价中应用的必要性及注意事项. 中国循证医学杂志, 2013, 13(12): 1401-1404.
15.	李婷, 弓旭东, 张雪峰, 等. 他汀预防心脏介入手术患者造影剂肾病的Meta分析. 中国循证医学杂志, 2015, 15(11): 1277-1283.
16.	Wang N, Qian P, Kumar S, et al. The effect of N-acetylcysteine on the incidence of contrast-induced kidney injury: a systematic review and trial sequential analysis. Int J Cardiol, 2016, 209: 319-327.
17.	张斌, 梁龙, 陈文波, 等. 碳酸氢钠预防对比剂肾病疗效的Meta分析. 临床放射学杂志, 2015, 34(7): 1152-1158.
18.	齐春霞, 吴伟, 褚庆民, 等. 丹红注射液联合水化预防造影剂肾病疗效的系统评价与Meta分析. 中西医结合心脑血管病杂志, 2017, 15(5): 570-573.
19.	唐庚, 马根山. 维生素预防冠状动脉造影术后对比剂肾病的Meta分析. 中国循环杂志, 2018, 33(2): 181-186.
20.	习元堂, 袁丽宜, 徐思婷, 等. 丹参多酚酸盐静脉滴注联合水化预防造影剂肾病疗效的Meta分析. 中国中药杂志, 2019, 44(12): 2616-2626.
21.	Zang H, Zhang Q, Li X. Adenosine antagonists for prevention of contrast-induced nephropathy: a meta-analysis of randomized controlled trials with trial sequential analysis. Exp Ther Med, 2019, 18(1): 85-98.
22.	Pranata R, Vania R, Alkatiri AA, et al. Nicorandil reduces the incidence of contrast-induced nephropathy in patients undergoing coronary angiography/intervention-systematic review and meta-analysis of randomized controlled trials including GRADE qualification. Cardiovasc Revasc Med, 2020, 21(9): 1121-1127.
23.	马光, 王国良, 侯德和, 等. 别嘌呤醇联合水化对冠状动脉介入术后造影剂肾病预防作用的Meta分析. 中国循证心血管医学杂志, 2020, 12(7): 788-793.
24.	Xu H, Wang H, Zhang C, et al. Efficacy of alprostadil in preventing contrast-induced nephropathy: a systematic review and meta-Analysis. Angiology, 2021, 72(9): 878-888.
25.	Hu MJ, Luo EF, Tang CC, et al. Meta-analysis of the effects of furosemide combined with hydration therapy on contrast-induced acute kidney injury after coronary intervention. Eur Rev Med Pharmacol Sci, 2021, 25(14): 4729-4737.
26.	Martha JW, Pranata R, Wibowo A, et al. The effect of trimetazidine on contrast-induced nephropathy in patients undergoing coronary angiography and/or percutaneous coronary intervention - a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci, 2021, 25(7): 3045-3053.
27.	李思淼, 梁宇, 赵春阳, 等. 普罗布考预防对比剂肾病的Meta分析. 药物评价研究, 2019, 42(8): 1637-1643.
28.	巴文强, 李艳, 陈力群, 等. 脑利钠肽预防造影剂肾病疗效的meta分析. 中南药学, 2021, 19(2): 338-345.
29.	Prasad A, Sohn A, Morales J, et al. Contemporary practice patterns related to the risk of acute kidney injury in the catheterization laboratory: results from a survey of Society of Cardiovascular Angiography and Intervention (SCAI) cardiologists. Catheter Cardiovasc Interv, 2017, 89(3): 383-392.
30.	樊泽元, 季汉华. 曲美他嗪对肾功能不全患者冠脉介入术后造影剂肾病的预防作用. 实用医学杂志, 2017, 33(15): 2558-2562.
31.	Fragasso G, Rosano G, Baek SH, et al. Effect of partial fatty acid oxidation inhibition with trimetazidine on mortality and morbidity in heart failure: results from an international multicentre retrospective cohort study. Int J Cardiol, 2013, 163(3): 320-325.
32.	Zhang Q, Chen L, Si Z, et al. Probucol protects endothelial progenitor cells against oxidized low-density lipoprotein via suppression of reactive oxygen species formation in vivo. Cell Physiol Biochem, 2016, 39(1): 89-101.
33.	索新祺, 杨世诚, 马振华, 等. 普罗布考对冠心病患者介入治疗术后对比剂肾病的预防作用. 中华医学杂志, 2017, 97(41): 3234-3238.
34.	张彩香, 渠风琴, 韩重阳. 大鼠糖尿病造影剂肾病中中性粒细胞明胶酶相关脂质运载蛋白的表达水平及普罗布考的保护作用. 中华生物医学工程杂志, 2019, 25(1): 36-41.
35.	Solomon R. Forced diuresis with the RenalGuard system: impact on contrast induced acute kidney injury. J Cardiol, 2014, 63(1): 9-13.
36.	Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA, 2004, 291(19): 2328-2334.
37.	陈鹏, 牛琳琳, 朱明军, 等. 中药对冠脉介入术后造影剂肾病防治的作用机制浅析. 中国中西医结合杂志, 2016, 36(8): 991-993.
38.	李逸雯, 刘艳飞, 崔京, 等. 冠心病中医药诊疗指南的方法学质量评价. 中国循证医学杂志, 2021, 21(6): 696-702.
39.	Shojania KG, Sampson M, Ansari MT, et al. How quickly do systematic reviews go out of date: a survival analysis. Ann Intern Med, 2007, 147(4): 224-233.

1. Virani SS, Alonso A, Aparicio HJ, et al. Heart disease and stroke statistics-2021 update: a report from the American Heart Association. Circulation, 2021, 143(8): e254-e743.
2. 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2020概要. 中国循环杂志, 2021, 36(6): 521-545.
3. 中华医学会心血管病学分会介入心脏病学组, 中华医学会心血管病学分会大血管病学组, 中华心血管病杂志编辑委员会. 经动脉心血管介入诊治中含碘对比剂相关不良反应防治的中国专家共识(2021). 中华心血管病杂志, 2021, 49(10): 972-985.
4. Lun Z, Liu L, Chen G, et al. The global incidence and mortality of contrast-associated acute kidney injury following coronary angiography: a meta-analysis of 1. 2 million patients. J Nephrol, 2021, 34(5): 1479-1489.
5. Bei W, Li H, Lin K, et al. Post-Hoc Study: intravenous hydration treatment in Chinese patients with high risk of contrast-induced nephropathy following percutaneous coronary intervention. Sci Rep, 2017, 7: 45023.
6. Su X, Xie X, Liu L, et al. Comparative effectiveness of 12 treatment strategies for preventing contrast-induced acute kidney injury: a systematic review and Bayesian network meta-analysis. Am J Kidney Dis, 2017, 69(1): 69-77.
7. Giacoppo D, Gargiulo G, Buccheri S, et al. Preventive strategies for contrast-induced acute kidney injury in patients undergoing percutaneous coronary procedures: evidence from a hierarchical Bayesian network meta-analysis of 124 trials and 28 240 patients. Circ Cardiovasc Interv, 2017, 10(5): e004383.
8. 中华医学会放射学分会质量控制与安全管理专业委员会. 肾病患者静脉注射碘对比剂应用专家共识. 中华放射学杂志, 2021, 55(6): 580-590.
9. 高洪阳, 赵阳, 高蕊, 等. Cochrane Overview的研究现状及制作方法调查. 中国循证医学杂志, 2014, 14(12): 1514-1519.
10. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ, 2009, 339: b2535.
11. 王靖, 刘琴, 翁淳光, 等. 国内公共卫生研究领域系统评价/Meta分析的质量评价. 中国循证医学杂志, 2010, 10(12): 1367-1374.
12. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
13. 张方圆, 沈傲梅, 曾宪涛, 等. 系统评价方法学质量评价工具AMSTAR 2解读. 中国循证心血管医学杂志, 2018, 10(1): 14-18.
14. 陈耀龙, 姚亮, Susan Norris, 等. GRADE在系统评价中应用的必要性及注意事项. 中国循证医学杂志, 2013, 13(12): 1401-1404.
15. 李婷, 弓旭东, 张雪峰, 等. 他汀预防心脏介入手术患者造影剂肾病的Meta分析. 中国循证医学杂志, 2015, 15(11): 1277-1283.
16. Wang N, Qian P, Kumar S, et al. The effect of N-acetylcysteine on the incidence of contrast-induced kidney injury: a systematic review and trial sequential analysis. Int J Cardiol, 2016, 209: 319-327.
17. 张斌, 梁龙, 陈文波, 等. 碳酸氢钠预防对比剂肾病疗效的Meta分析. 临床放射学杂志, 2015, 34(7): 1152-1158.
18. 齐春霞, 吴伟, 褚庆民, 等. 丹红注射液联合水化预防造影剂肾病疗效的系统评价与Meta分析. 中西医结合心脑血管病杂志, 2017, 15(5): 570-573.
19. 唐庚, 马根山. 维生素预防冠状动脉造影术后对比剂肾病的Meta分析. 中国循环杂志, 2018, 33(2): 181-186.
20. 习元堂, 袁丽宜, 徐思婷, 等. 丹参多酚酸盐静脉滴注联合水化预防造影剂肾病疗效的Meta分析. 中国中药杂志, 2019, 44(12): 2616-2626.
21. Zang H, Zhang Q, Li X. Adenosine antagonists for prevention of contrast-induced nephropathy: a meta-analysis of randomized controlled trials with trial sequential analysis. Exp Ther Med, 2019, 18(1): 85-98.
22. Pranata R, Vania R, Alkatiri AA, et al. Nicorandil reduces the incidence of contrast-induced nephropathy in patients undergoing coronary angiography/intervention-systematic review and meta-analysis of randomized controlled trials including GRADE qualification. Cardiovasc Revasc Med, 2020, 21(9): 1121-1127.
23. 马光, 王国良, 侯德和, 等. 别嘌呤醇联合水化对冠状动脉介入术后造影剂肾病预防作用的Meta分析. 中国循证心血管医学杂志, 2020, 12(7): 788-793.
24. Xu H, Wang H, Zhang C, et al. Efficacy of alprostadil in preventing contrast-induced nephropathy: a systematic review and meta-Analysis. Angiology, 2021, 72(9): 878-888.
25. Hu MJ, Luo EF, Tang CC, et al. Meta-analysis of the effects of furosemide combined with hydration therapy on contrast-induced acute kidney injury after coronary intervention. Eur Rev Med Pharmacol Sci, 2021, 25(14): 4729-4737.
26. Martha JW, Pranata R, Wibowo A, et al. The effect of trimetazidine on contrast-induced nephropathy in patients undergoing coronary angiography and/or percutaneous coronary intervention - a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci, 2021, 25(7): 3045-3053.
27. 李思淼, 梁宇, 赵春阳, 等. 普罗布考预防对比剂肾病的Meta分析. 药物评价研究, 2019, 42(8): 1637-1643.
28. 巴文强, 李艳, 陈力群, 等. 脑利钠肽预防造影剂肾病疗效的meta分析. 中南药学, 2021, 19(2): 338-345.
29. Prasad A, Sohn A, Morales J, et al. Contemporary practice patterns related to the risk of acute kidney injury in the catheterization laboratory: results from a survey of Society of Cardiovascular Angiography and Intervention (SCAI) cardiologists. Catheter Cardiovasc Interv, 2017, 89(3): 383-392.
30. 樊泽元, 季汉华. 曲美他嗪对肾功能不全患者冠脉介入术后造影剂肾病的预防作用. 实用医学杂志, 2017, 33(15): 2558-2562.
31. Fragasso G, Rosano G, Baek SH, et al. Effect of partial fatty acid oxidation inhibition with trimetazidine on mortality and morbidity in heart failure: results from an international multicentre retrospective cohort study. Int J Cardiol, 2013, 163(3): 320-325.
32. Zhang Q, Chen L, Si Z, et al. Probucol protects endothelial progenitor cells against oxidized low-density lipoprotein via suppression of reactive oxygen species formation in vivo. Cell Physiol Biochem, 2016, 39(1): 89-101.
33. 索新祺, 杨世诚, 马振华, 等. 普罗布考对冠心病患者介入治疗术后对比剂肾病的预防作用. 中华医学杂志, 2017, 97(41): 3234-3238.
34. 张彩香, 渠风琴, 韩重阳. 大鼠糖尿病造影剂肾病中中性粒细胞明胶酶相关脂质运载蛋白的表达水平及普罗布考的保护作用. 中华生物医学工程杂志, 2019, 25(1): 36-41.
35. Solomon R. Forced diuresis with the RenalGuard system: impact on contrast induced acute kidney injury. J Cardiol, 2014, 63(1): 9-13.
36. Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA, 2004, 291(19): 2328-2334.
37. 陈鹏, 牛琳琳, 朱明军, 等. 中药对冠脉介入术后造影剂肾病防治的作用机制浅析. 中国中西医结合杂志, 2016, 36(8): 991-993.
38. 李逸雯, 刘艳飞, 崔京, 等. 冠心病中医药诊疗指南的方法学质量评价. 中国循证医学杂志, 2021, 21(6): 696-702.
39. Shojania KG, Sampson M, Ansari MT, et al. How quickly do systematic reviews go out of date: a survival analysis. Ann Intern Med, 2007, 147(4): 224-233.

Chinese Journal of Evidence-Based Medicine

Efficacy of different pharmacological interventions in the prevention of contrast-induced acute kidney injury after percutaneous coronary intervention: an overview of systematic reviews

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