Contrast-Induced Nephropathy: Update on the Use of Crystalloids and Pharmacological Measures
Table 2
Summary of clinical trials related to CIN protective effects of different pharmacological strategies.
Substance
CIN protection
No CIN protection
Ascorbic acid
Meta-analysis of nine RCTs, 33% lower CIN risk if compared to either placebo or to alternative pharmacological regimen (risk ratio by random-effects model: 0.672; 95% confidence interval, 0.466 to 0.969; ) [13]
Meta-analysis of multiple substances including ascorbic acid, no superiority as compared to saline (odds ratio active treatment versus saline: 1.84; 95% confidence interval: 0.16 to 24.98) [14]
Fenoldopam
None
(i) Prospective, placebo-controlled, double-blind, multicenter RCT, CIN incidences in fenoldopam versus placebo: 33.6 versus 30.1%; [15] (ii) Prospective, randomized trial, CIN incidences in saline versus saline + fenoldopam versus saline + ACC: 15.3 versus 15.7 versus 17.1%; [16]
Probucol
(i) Prospective, randomized trial, CIN incidences in probucol + hydration versus hydration alone: 4 versus 10.9%; value significant [17] (ii) Meta-analysis of multiple substances including probucol, further odds ratio reduction with probucol odds ratio active treatment versus saline 0.27; 95% confidence interval: 0.09 to 0.79 [14]
None
Prostaglandins
Two meta-analyses indicated beneficial effects of different types of prostaglandins in CIN prevention [14, 18]
None
Statins
(i) Benefit of combined administration of high-dose statins and saline [19] (ii) Meta-analysis published by Liang et al.: diabetic subjects benefit from moderate or high-dose rosuvastatin [20]
(i) Rezaei et al. [24]: additional administration of tocopherol prior to elective coronary intervention lowered CIN risk further (ii) Benefit in two other randomized controlled trials [25, 26]
None
Trimetazidine
Meta-analysis published by Ye and colleagues [18]: 6 randomized controlled trials indicate additional CIN protection by the substance
