Effect of remote ischemic preconditioning, nicorandil, and trimetazidine in contrast-induced nephropathy: a network meta-analysis of randomized controlled trials

Abstract

Introduction Contrast-induced nephropathy (CIN) is a potential complication associated with the administration of intravenous contrast agents. The objective of this study was to evaluate the effectiveness of remote ischemic preconditioning (RIPC) and two pharmacological interventions in preventing CIN. Methods Randomized controlled trials (RCTs) examining the efficacy of RIPC, nicorandil, and trimetazidine in treating CIN were searched within databases such as PubMed, Cochrane Library, Embase, and Web of Science. The primary outcome was the incidence of CIN. The consistency model was used to address heterogeneity and enhance model fit. The assessment of consistency between direct and indirect evidence was conducted through the node-splitting method. Posterior probability estimates and surface under the cumulative ranking area (SUCRA) ranked interventions based on their effectiveness in preventing CIN. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used to grade the quality of evidence. Results Based on hydration therapy, RIPC, nicorandil, and trimetazidine all showed prophylactic effects on CIN compared to control groups. The SUCRA results showed that RIPC (SUCRA = 37.7%, PrBest = 0.4%), nicorandil (SUCRA = 91.2%, PrBest = 74.7%), and trimetazidine (SUCRA = 71.0%, PrBest = 24.9%). However, there were no significant differences between the nicorandil, RIPC, and trimetazidine groups. Subgroup analysis suggested that there was still a protective effect in populations with mean estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m 2 or with a high prevalence of diabetes mellitus. Conclusions Nicorandil, trimetazidine, and RIPC all showed renal protective effects. Based on hydration, nicorandil, trimetazidine, and RIPC may show better prophylaxis against CIN than hydration alone after intravenous contrast administration.