Advertisement

International Urology and Nephrology

, Volume 51, Issue 12, pp 2267–2272 | Cite as

The effect of trimetazidine on preventing contrast-induced nephropathy after cardiac catheterization

  • Xingji Lian
  • Wenfei He
  • Huimin Zhan
  • Jiyan Chen
  • Ning Tan
  • Pengcheng HeEmail author
  • Yuanhui LiuEmail author
Nephrology - Original Paper
  • 51 Downloads

Abstract

Purpose

Trimetazidine has been shown to prevent the risk of contrast-induced nephropathy (CIN) in patients with renal dysfunction undergoing percutaneous coronary intervention (PCI). However, the effect of trimetazidine on CIN in unselected patients is unknown. We aimed to evaluate the effect of trimetazidine on preventing CIN in unselected patients treated with PCI.

Methods

2154 consecutive patients were enrolled and divided into the trimetazidine (n = 529) and non-trimetazidine group (n = 1625). Patients in the trimetazidine group received trimetazidine 20 mg thrice daily starting at least 24 h before the procedure and continuing until discharge. The primary outcome was CIN.

Results

CIN was observed in 197 (9.2%) patients. The incidence of CIN was similar between two groups (9.1% vs. 9.2%, P = 0.947). After adjusting for other potential risk factors, trimetazidine did not significantly reduce the risk of CIN (OR = 0.70, 95% CI 0.46–1.08, P = 0.104). The results remained similar when using the alternate definitions of CIN and different subgroup analysis based on diabetes or chronic kidney disease. In additional, no significant difference between two groups was found with respect to in-hospital major adverse clinical events (1.89% vs. 1.66%, P > 0.05).

Conclusions

Trimetazidine did not exert significant renal protective effect on preventing CIN and in hosptial major adverse clinical events in unselected patients undergoing PCI.

Keywords

Trimetazidine Contrast-induced nephropathy Percutaneous coronary intervention Risk factors 

Notes

Acknowledgements

This study was supported by a Grant from the National Science Foundation for Young Scientists of China (Grant No. 81800325) and Science and Technology Planning Project of Guangzhou City (201906010089), and Medical Science and Technology Research Funding of Guangdong (A2017347), and China Youth Research Funding (2017-CCA-VG-018), and the Medjaden Academy & Research Foundation for Young Scientists (Grant No. MJR20160025). The funders had no role in the study design, data collection and analysis, the decision to publish, or the preparation of the manuscript. The work was not funded by any industry sponsors. All authors agreed to submit the manuscript for publication.

Compliance with ethical standards

Conflict of interest

The authors of the present manuscript have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11255_2019_2308_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 17 kb)

References

  1. 1.
    Fliser D, Laville M, Covic A, Fouque D, Vanholder R, Juillard L, Van Biesen W (2012) A European renal best practice (ERBP) position statement on the kidney disease improving global outcomes (KDIGO) clinical practice guidelines on acute kidney injury: part 1: definitions, conservative management and contrast-induced nephropathy. Nephrol Dial Transplant 27(12):4263–4272CrossRefGoogle Scholar
  2. 2.
    Marenzi G, Ferrari C, Marana I, Assanelli E, De Metrio M, Teruzzi G, Veglia F, Fabbiocchi F, Montorsi P, Bartorelli AL (2012) Prevention of contrast nephropathy by furosemide with matched hydration: the MYTHOS (induced diuresis with matched hydration compared to standard hydration for contrast induced nephropathy prevention) trial. JACC Cardiovasc Interv 5(1):90–97CrossRefGoogle Scholar
  3. 3.
    Wilhelm-Leen E, Montez-Rath ME, Chertow G (2017) Estimating the risk of radiocontrast-associated nephropathy. J Am Soc Nephrol 28(2):653–659CrossRefGoogle Scholar
  4. 4.
    Abe M, Morimoto T, Akao M, Furukawa Y, Nakagawa Y, Shizuta S, Ehara N, Taniguchi R, Doi T, Nishiyama K, Ozasa N, Saito N, Hoshino K, Mitsuoka H, Toma M, Tamura T, Haruna Y, Kita T, Kimura T (2014) Relation of contrast-induced nephropathy to long-term mortality after percutaneous coronary intervention. Am J Cardiol 114(3):362–368CrossRefGoogle Scholar
  5. 5.
    Azzalini L, Garciamoll X (2017) On contrast-induced acute kidney injury, risk prediction, and the future of predictive model development. Can J Cardiol 33(6):711–713CrossRefGoogle Scholar
  6. 6.
    Afshar AE, Parikh PB (2018) Prevention of contrast and radiation injury during coronary angiography and percutaneous coronary intervention. Curr Treat Options Cardiovasc Med 20(4):32CrossRefGoogle Scholar
  7. 7.
    Patschan D, Buschmann I, Ritter O (2018) Contrast-induced nephropathy: update on the use of crystalloids and pharmacological measures. Int J Nephrol 5727309:2018.  https://doi.org/10.1155/2018/5727309.eCollection CrossRefGoogle Scholar
  8. 8.
    Kallistratos MS, Poulimenos LE, Giannitsi S (2019) Trimetazidine in the prevention of tissue ischemic conditions. Angiology 70(4):291–298CrossRefGoogle Scholar
  9. 9.
    Aygen B, Celiker H, Dogukan A, Ilhan N (2008) The effects of trimetazidine on lipid peroxidation in patients with end-stage renal disease. Methods Find Exp Clin Pharmacol 30(10):757–760CrossRefGoogle Scholar
  10. 10.
    Ye Z, Lu H, Su Q, Guo W, Dai W, Li HQ, Hf Yang, Li L (2017) Clinical effect of trimetazidine on prevention of contrast-induced nephropathy in patients with renal insufficiency: an updated systematic review and meta-analysis. Medicine 96(9):e6059CrossRefGoogle Scholar
  11. 11.
    Ibrahim TA, El-Mawardy RH, El-Serafy AS, El-Fekky EM (2017) Trimetazidine in the prevention of contrast-induced nephropathy in chronic kidney disease. Cardiovasc Revasc Med 18(5):315–319CrossRefGoogle Scholar
  12. 12.
    Rahman MM, Haque SS, Rokeya B, Siddique MA, Banerjee SK, Ahsan SA, Rahman F, Mahmood M, Ahmed K, Bhuiyan MM (2012) Trimetazidine in the prevention of contrast induced nephropathy after coronary angiogram. Mymensingh Med J 21(2):292–299PubMedGoogle Scholar
  13. 13.
    Liu W, Ming Q, Shen J, Wei Y, Li W, Chen W, Xu Y (2015) Trimetazidine prevention of contrast-induced nephropathy in coronary angiography. Am J Med Sci 350(5):398–402CrossRefGoogle Scholar
  14. 14.
    Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612CrossRefGoogle Scholar
  15. 15.
    Stacul F, Aj VDM, Reimer P, Webb JA, Thomsen HS, Morcos SK, Almén T, Aspelin P, Bellin MF, Clement O (2011) Contrast induced nephropathy: updated ESUR contrast media safety committee guidelines. Eur Radiol 21(12):2527–2541CrossRefGoogle Scholar
  16. 16.
    Scharnweber T, Alhilali L, Fakhran S (2017) Contrast-induced acute kidney injury: pathophysiology, manifestations, prevention, and management. Magn Reson Imaging Clin N Am 25(4):743–753CrossRefGoogle Scholar
  17. 17.
    Wang N, Wei RB, Li QP, Yang X, Li P, Huang MJ, Wang R, Cai GY, Chen XM (2015) Renal protective effect of probucol in rats with contrast-induced nephropathy and its underlying mechanism. Med Sci Monit 21:2886–2892CrossRefGoogle Scholar
  18. 18.
    Steg PG, Grollier G, Gallay P, Morice M, Karrillon GJ, Benamer H, Kempf C, Laperche T, Arnaud P, Sellier P (2001) A randomized double-blind trial of intravenous trimetazidine as adjunctive therapy to primary angioplasty for acute myocardial infarction. Int J Cardiol 77(2):263–273CrossRefGoogle Scholar
  19. 19.
    Zhang N, Lei J, Liu Q, Huang W, Xiao H, Lei H (2015) The effectiveness of preoperative trimetazidine on myocardial preservation in coronary artery bypass graft patients: a systematic review and meta-analysis. Cardiology 131(2):86–96CrossRefGoogle Scholar
  20. 20.
    Onbasili AO, Yeniceriglu Y, Agaoglu P, Karul A, Tekten T, Akar H, Discigil Guzel (2007) Trimetazidine in the prevention of contrast-induced nephropathy after coronary procedures. Heart 93(6):698–702CrossRefGoogle Scholar
  21. 21.
    Shehata M (2014) Impact of trimetazidine on incidence of myocardial injury and contrast-induced nephropathy in diabetic patients with renal dysfunction undergoing elective percutaneous coronary intervention. Am J Cardiol 114(3):389–394CrossRefGoogle Scholar
  22. 22.
    Ye Z, Lu H, Su Q, Xian X, Li L (2017) Effect of trimetazidine on preventing contrast-induced nephropathy in diabetic patients with renal insufficiency. Oncotarget 8(60):102521–102530CrossRefGoogle Scholar
  23. 23.
    Shalansky SJ, Vu T, Pate GE, Levin A, Humphries KH, Webb JG (2012) N-acetylcysteine for prevention of radiographic contrast material-induced nephropathy: is the intravenous route best? Pharmacotherapy 25(8):1095–1103CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of NephrologyGuangdong Provincial Geriatrics Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesGuangzhouChina
  2. 2.Department of CardiologyThe Second People’s Hospital of Nanhai District, Guangdong Provincial People’s Hospital’s Nanhai HospitalFoshanChina
  3. 3.Department of CardiologyGuangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesGuangzhouChina

Personalised recommendations