title: Trimetazidine Decreases Risk of Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease: A Meta-Analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  We sought to synthesize and analyze the available data from randomized controlled trials (RCTs) for trimetazidine (TMZ) in the prevention of contrast-induced nephropathy (CIN).
  
  
  BACKGROUND
  Contrast-induced nephropathy after coronary angiography is associated with poor outcomes. Trimetazidine is an anti-ischemic drug that might reduce incidence of CIN, but current data are inconclusive.
  
  
  METHODS
  We searched MEDLINE/PubMed, EMBASE, Scopus, Cochrane Library, Web of Science, and ScienceDirect electronic databases for RCTs comparing intravenous hydration with normal saline (NS) and/or N-acetyl cysteine (NAC) versus TMZ plus NS ± NAC for prevention of CIN. We used RevMan 5.2 for statistical analysis with the fixed effects model.
  
  
  RESULTS
  Of the 808 studies, 3 RCTs met criteria with 290 patients in the TMZ plus NS ± NAC group and 292 patients in the NS ± NAC group. The mean age of patients was 59.5 years, and baseline serum creatinine ranged from 1.3 to 2 mg/dL. Trimetazidine significantly reduced the incidence of CIN by 11% (risk difference 0.11; 95% confidence interval, 0.16-0.06; P < .01). There was no significant heterogeneity between the studies (I(2) statistic = 0). The number needed to treat to prevent 1 episode of CIN was 9.
  
  
  CONCLUSIONS
  The addition of TMZ to NS ± NAC significantly decreased the incidence of CIN in patients undergoing coronary angiography. In conclusion, TMZ could be considered as a potential tool for prevention of CIN in patients with renal dysfunction.
authors.affiliation: Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA gnadkarni1178@gmail.com.
authors.forename: Girish N
authors.initials: GN
authors.lastname: Nadkarni
authors.affiliation: Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Konstantinidis
authors.affiliation: Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Achint
authors.initials: A
authors.lastname: Patel
authors.affiliation: Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Rabi
authors.initials: R
authors.lastname: Yacoub
authors.affiliation: Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Damodar
authors.initials: D
authors.lastname: Kumbala
authors.affiliation: Division of Cardiology, Department of Medicine, Ochsner Clinic Foundation, Jefferson, LA, USA.
authors.forename: Rajan A G
authors.initials: RA
authors.lastname: Patel
authors.affiliation: Division of Rheumatology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Narender
authors.initials: N
authors.lastname: Annapureddy
authors.affiliation: Department of Medicine, Baton Rouge General Hospital, Baton Rouge, LA, USA.
authors.forename: Krishna Chaitanya
authors.initials: KC
authors.lastname: Pakanati
authors.affiliation: Department of Medicine, St. Luke's Roosevelt Hospital Center at Mount Sinai, New York, NY, USA.
authors.forename: Priya K
authors.initials: PK
authors.lastname: Simoes
authors.affiliation: Division of Cardiology, Department of Medicine, Ochsner Clinic Foundation, Jefferson, LA, USA.
authors.forename: Fahad
authors.initials: F
authors.lastname: Javed
authors.affiliation: Division of Cardiology, Department of Medicine, Ochsner Clinic Foundation, Jefferson, LA, USA.
authors.forename: Alexandre M
authors.initials: AM
authors.lastname: Benjo
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D014292:Trimetazidine / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D003287:Contrast Media; D014665:Vasodilator Agents; D014292:Trimetazidine
keywords: acute renal disease; cardiac catheterization; evidence based medicine