Preventive effect of oral nicorandil on contrast-induced nephropathy in patients with renal insufficiency undergoing elective cardiac catheterization

Abstract

This study aims to investigate the preventive effect of oral nicorandil on contrast-induced nephropathy (CIN) in patients with renal insufficiency undergoing elective cardiac catheterization. A total of 240 patients with an estimated glomerular filtration rate (eGFR) of 60 mL/min or less, who were undergoing elective cardiac catheterization, were randomly assigned to nicorandil group (n = 120, 10 mg nicorandil, three times daily from 2 days before to 3 days after procedure) or control group (n = 120, matching placebo as the same method). The primary endpoint was the incidence of CIN defined as 25 % increase in serum creatinine (SCr) from baseline or 44 μmol/L (0.5 mg/dL) increase in absolute value within 72 h after exposure to contrast medium. The secondary endpoints were: (1) the changes of SCr, Cystatin-C (Cys-C) and eGFR within 72 h; (2) major adverse events (MACE) occurring within 30 days. Baseline characteristics of the patients in the two groups were similar. The incidence of CIN was significantly lower in nicorandil group compared with control group (6.67 vs. 17.5 %, P = 0.017). Compared with the control group, nicorandil group tended to have a lower SCr and Cys-C levels as well as a higher eGFR at 48 h after the procedure (all P < 0.05). There was no difference about the incidence of MACE within 30 days between nicorandil group and control group (4.16 vs. 5.83 %, P = 0.767). Multivariate logistic analysis showed that nicorandil was an independent protective factor against CIN (OR = 0.260, 95 % CI = 0.1-0.676, P = 0.006). Therefore, we concluded that oral nicorandil was associated with a decline in the incidence of CIN in patients with renal insufficiency undergoing elective cardiac catheterization.

Nicorandil for the prevention of contrast‐induced nephropathy: A meta‐analysis of randomized controlled trials

“…The remaining 8 RCTs underwent full‐text review and 4 were further excluded because three of them were repeated abstracts of already included RCTs, and the other one was not with the treatment arm of nicorandil. Finally, four RCTs were included.…”

“…Overall, four RCTs including 709 patients with renal dysfunction or at risk for CIN, who were scheduled for coronary angiography (CAG) or percutaneous coronary intervention (PCI), were included . All of the RCTs were performed in Asian countries.…”

“…As for the regimens of nicorandil applied, i.v. injection of 12 mg or 96 mg nicorandil were applied in two RCTs, respectively, while nicorandil was orally administered with 10 mg three times a day or 10 mg once daily in the other two RCTs. As for the regimens of controls, two RCTs with i.v.…”

“…Indeed, early animal studies showed that K‐ATP channel openers, including nicorandil, may ameliorate renal injury related to oxidative stress or ischemia‐reperfusion injury . However, subsequent randomized controlled trials (RCTs) which evaluated the potential preventative efficacy of nicorandil against CIN showed inconsistent results . Therefore, in this study, we aimed to perform a meta‐analysis of RCTs to systematically evaluate the efficacy of periprocedural treatment of nicorandil on the incidence of CIN in patients undergoing contrast exposure.…”

Preventive effect of nicorandil on contrast‐induced nephropathy: a meta‐analysis of randomised controlled trials

“…4B). Table 1 Study population and nicorandil administration of included studies Ko et al 5 Nawa et al 10 Fan et al 11 Iranirad et al 12 Study Change in cystatin C Pooled analysis of percentage change in cystatin C from baseline showed that, compared with control, nicorandil was associated with a non-significant trend towards decreased cystatin C (WMD = −2.18%, 95% CI: −4.39 to 0.02) ( Fig. 5A).…”