Photo Credit: Ekaterina Chizhevskaya

The following is a summary of “Trimetazidine as an adjunct to standard hydration reduces the incidence of contrast-induced acute kidney injury in patients with renal insufficiency undergoing coronary angiography or percutaneous cardiac intervention: a systematic review and meta-analysis.,” published in the December 2024 issue of Nephrology by Lukwaro et al. 

Contrast-induced acute kidney injury (CI-AKI) is a common complication after coronary angiography (CAG) or percutaneous coronary intervention (PCI). Trimetazidine (TMZ), an anti-ischemic drug, may reduce its risk. 

Researchers conducted a retrospective study to evaluate the role of trimetazidine in preventing CI-AKI in patients with renal dysfunction undergoing CAG or PCI. 

They searched PubMed, Cochrane Library, EBSCOhost, Web of Science, and Google Scholar from January 2004 to January 2024 for RCTs involving participants aged ≥18 years with renal insufficiency undergoing CAG or PCI. They focused on outcomes such as CI-AKI incidence, adverse events (AEs), and changes in serum creatinine (Scr) levels. The 2 reviewers independently extracted data, assessed study quality, and graded evidence strength through consensus. 

The results showed that nine RCTs assessed TMZ in patients with renal dysfunction undergoing CAG or PCI. All RCTs demonstrated a significant reduction in CI-AKI incidence in the TMZ group (RR 0.36, 95% CI [0.25, 0.52], P < 0.001). Changes in Scr at 24 h (SMD -0.33, 95% CI [-0.56, -0.10], P = 0.01), 48 h (SMD -0.27, 95% CI [-0.46, -0.09], P = 0.01), and 72 h (SMD -0.32, 95% CI [-0.56, -0.07], P = 0.01) were significant. However, changes in Scr beyond 72 h were not significant (SMD -0.22, 95% CI [-0.52, 0.09], P = 0.16). The incidence of adverse effects was lower in the TMZ group (RR 0.51, 95% CI [0.29, 0.90], P = 0.02). 

Investigators concluded that adding TMZ to standard hydration protocols effectively reduced the incidence of CI-AKI, AEs, and postoperative Scr levels in patients with renal insufficiency after CAG or PCI. However, large-scale RCTs were needed to confirm their efficacy and safety. 

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03872-9