Brain natriuretic peptide for prevention of contrast-inducednephropathy: a meta-analysis of randomized controlled trials.
OBJECTIVE
Contrast-induced nephropathy (CIN) is a serious complication and associated with poor clinical outcomes. The protective value of brain natriuretic peptide (BNP) administration on CIN is still controversial in patients undergoing percutaneous coronary intervention (PCI) or coronary angiography (CAG). We performed a meta-analysis of randomized controlled trials (RCTs) for BNP in preventing CIN.


METHODS
We systematically searched PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov for RCTs comparing administration of BNP versus non-BNP for preventing CIN. Publication bias was assessed by funnel plots. Relative risk (RR) was calculated for incidence of CIN and major adverse cardiovascular events (MACEs) using the random or fixed effect model according to heterogeneity analysis.


RESULTS
There were five RCTs with 1441 patients in this analysis. BNP treatment was associated with lower incidence of CIN (RR = 0.38, 95 % CI 0.27-0.54, p < 0.001) and MACEs (RR = 0.47, 95 % CI 0.24-0.95, p = 0.034) with no significant heterogeneity (I2= 0 %, p = 0.701; I2= 60 %, p = 0.113, respectively). Similar results were seen in subgroup analysis. Prophylactic BNP significantly decreased the incidence of CIN after cardiac catheterization in the studies of regarding sodium chloride as placebo (I2= 0 %, RR = 0.39, 95 % CI 0.27-0.56, p < 0.001) or JADAD score > 3 (I2= 0 %, RR = 0.38, 95 % CI 0.21-0.68, p = 0.001).


CONCLUSIONS
Preprocedural BNP treatment significantly decreased the incidence of CIN and short-term MACEs in patients undergoing PCI or CAG.
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, China.
Xue-Biao
XB
Wei
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, China.
Lei
L
Jiang
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, China.
Xin-Rong
XR
Liu
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, China.
Dan-Qing
DQ
Yu
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, China.
Ning
N
Tan
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, China.
Ji-Yan
JY
Chen
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, China.
Ying-Ling
YL
Zhou
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, China. gdhpc100@126.com.
Peng-Cheng
PC
He
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, China. lyh0718@126.com.
Yuan-Hui
YH
Liu
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000188:drug therapy*; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention; D016032:Randomized Controlled Trials as Topic
D003287:Contrast Media; D020097:Natriuretic Peptide, Brain
Brain natriuretic peptide; Contrast-induced nephropathy; Coronary angiography; Meta-analysis; Percutaneous coronary intervention
Acta Radiol. 2010 Jul;51(6):641-8
20438292
BMJ. 1994 Jun 18;308(6944):1615-9
8025431
Int J Cardiol. 2015 Mar 15;183:47-53
25662053
Am J Cardiol. 2006 Sep 18;98(6A):14K-20K
16949376
Minerva Med. 2008 Apr;99(2):177-96
18431326
Heart Vessels. 2016 Apr;31(4):490-8
25637044
Eur Heart J. 2014 Jun 14;35(23):1533-40
24603308
Handb Exp Pharmacol. 2009;(191):341-66
19089336
N Engl J Med. 2000 Jul 27;343(4):246-53
10911006
Circ Cardiovasc Interv. 2013 Feb;6(1):37-43
23322741
Int J Clin Exp Med. 2015 Aug 15;8(8):14166-72
26550389
Value Health. 2010 Aug;13(5):643-8
20345547
Circulation. 2002 May 14;105(19):2259-64
12010907
Ann Intern Med. 2016 Mar 15;164(6):406-16
26830221
Circulation. 2006 Apr 11;113(14):1799-806
16606801
Can J Cardiol. 2014 Dec;30(12 ):1607-12
25418218
Am J Physiol Renal Physiol. 2003 Aug;285(2):F167-77
12842858
J Clin Endocrinol Metab. 1993 Jan;76(1):91-6
8380606
Congest Heart Fail. 2005 Jan-Feb;11(1):30-8
15722668
Crit Care. 2011;15(5):R258
22032777
J Am Coll Cardiol. 2008 Apr 15;51(15):1419-28
18402894
Am Heart J. 2002 Mar;143(3):406-11
11868044
Curr Probl Cardiol. 2004 Dec;29(12):707-69
15550914
Kidney Int. 2005 Jul;68(1):14-22
15954892
Int J Cardiol. 2014 Dec 15;177(2):505-9
25183537
Control Clin Trials. 1996 Feb;17(1):1-12
8721797
N Engl J Med. 1998 Jul 30;339(5):321-8
9682046
Biomed Res Int. 2016;2016:5985327
26949703
Eur Radiol. 2011 Dec;21(12 ):2527-41
21866433
J Cardiothorac Vasc Anesth. 2009 Apr;23(2):151-60
19167908
Am J Kidney Dis. 2002 May;39(5):930-6
11979336
Eur Heart J. 2012 Aug;33(16):2007-15
22267241
Circulation. 2005 Mar 29;111(12):1487-91
15781736