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The protective effects of Nicorandil on renal function in patients undergoing coronary interventions: a systematic
Ahmed A Abo Elnaga1, Ibrahim Saleh Alawadi1, Abdelrahman M Elettreby2
1Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Insights
Nicorandil effectively reduces contrast-induced nephropathy (CIN) incidence and creatinine rise in cardiac intervention patients. The drug demonstrates a favorable safety profile, making it a promising option for renal protection.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Contrast-induced nephropathy (CIN) poses a significant risk, particularly for patients with chronic kidney disease undergoing cardiac procedures.
- Assessing preventative strategies for CIN is crucial for improving patient outcomes in interventional cardiology.
Purpose of the Study:
- To evaluate the efficacy of Nicorandil in preventing contrast-induced nephropathy (CIN) in patients undergoing coronary interventions.
- To determine Nicorandil's impact on renal function markers, including serum creatinine and estimated glomerular filtration rate (eGFR).
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) published up to September 2024.
- Inclusion criteria focused on studies assessing Nicorandil's efficacy for CIN prevention in patients undergoing coronary procedures.
- Data from 11 trials involving 2837 patients were analyzed.
Main Results:
- Nicorandil significantly reduced CIN incidence (RR = 0.37, P < 0.001) without heterogeneity.
- A notable reduction in serum creatinine levels was observed at 24, 48, and 72 hours post-intervention (P < 0.01).
- No significant differences were found in eGFR or major adverse cardiovascular events between Nicorandil and control groups.
Conclusions:
- Nicorandil demonstrates significant efficacy in reducing CIN incidence and acute kidney injury markers.
- The drug exhibits a favorable safety profile, with no increased risk of major adverse events.
- Nicorandil represents a valuable therapeutic option for renal protection in patients undergoing coronary interventions.
Background:
Contrast-induced nephropathy (CIN) is a serious complication in patients undergoing cardiac interventions, especially in patients with chronic kidney disease. This study aims to assess the efficacy of Nicorandil in CIN reduction and its impact on renal function outcomes.
Methods:
A comprehensive search was conducted from inception to September, 2024 across four databases. Randomized controlled trials (RCTs) assessing the efficacy of Nicorandil for patients undergoing coronary procedures were included.
Results:
Based on analysis of 11 clinical trials involving 2837 patients, Nicorandil significantly reduced the incidence of CIN compared to control group (RR = 0.37, 95%CI [0.27 to 0.49], P < 0.001) without heterogeneity. Nicorandil group was superior to control group in reducing the rise in serum creatinine level at 24, 48 and 72 h (MD= -4.45 umol/L, 95%CI [-7.94 to -0.97], P = 0.01), (MD= -5.57 umol/L, 95%CI [-8.95 to -2.20], P < 0.001) and (MD= -5.70 umol/L, 95%CI [-9.57 to -1.82], P = 0.004) respectively. However, there was no statistically significant difference between Nicorandil group and control group regarding estimated glomerular filtration rate (eGFR) measured at 24, 48 and 72 h (MD = 2.17, 95%CI [-2.03 to 6.37], P = 0.31), (MD = 1.89, 95%CI [-0.15 to 3.93], P = 0.17) and (MD = 2.26, 95%CI [-0.37 to 4.89], P = 0.09) respectively. Nicorandil showed no statistically significant difference between both groups regarding any major adverse event, including stroke, myocardial infarction, conversion to emergency Percutaneous Coronary Intervention (PCI), or urgent need for dialysis.
Conclusion:
Nicorandil had an effective role in reducing the incidence of CIN, lower rise in creatinine, and a good safety profile in patients undergoing coronary interventions.
Clinical Trial Number:
Not applicable.
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