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.

Lukwaro, Andrew; Lu, Yi; Chen, Junzhe; Tang, Ying

doi:10.1186/s12882-024-03872-9

Table 1 Characteristics of included studies

From: 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.

Study, Year, (n)	Mean Age, y(SD) TMZ/Control	Baseline SCr mean (SD) TMZ /Control	DM (%) TMZ/ Control	HTN (%) TMZ/ Control	LVEF (%) mean (SD) TMZ/ Contro	TZM dosage (mg)	(IV) infusion 0.9% NS (mL/kg/hr)	Contrast agent	Contrast Dosage, Mean (SD)mL,TMZ/Control	Procedure	CI-AKI Definition	CKD Definition	Outcome measures
Fu et al. 2021, (n = 310) [34]	76.41 ± 4.27/77.14 ± 4.47	101.27 ± 14.24/100.94 ± 14.90	44.5/46.5	60.6/53.5	NA	20 mg TDS starting 24 h before PCI until 72 h after PCI	0.5–1 mL/kg/hr 12 h before and after PCI	Iopromide/ Iodixanol	140.90 ± 16.49/142.40 ± 14.82	PCI	CI-AKI 1	CrCl of 30-90 ml/min	CIN, SCr, Cys-C, CRP, and GFR and Adverse events
Mirhosseini et al. 2019 [35], (n = 100)	65 ± 6 /67 ± 6	1.27 ± 0.15/ 1.29 ± 0.15	64/62	68/56	51 ± 4 /51 ± 5	35 mg BID starting 48 h before CAG up to 24 h after CAG	1 ml/kg/hr 12 h before and after CAG	Iodixanol	116.80/ 121.80	CAG	CI-AKI 1	eGFR of 30–60 mL/min/1.73 m²	CIN, SCr, uNGAL
Chen et al. 2018 [36], (n = 150)	61.75(9.15)/63.52 (7.88)	118.18(17.27)/119.38 (14.81)	41.33/45.33	42.67/46.67	56.18(6.53)/54.62 (5.68)	20 mg TDS from 2 days before to 3 days after the procedure	0.5–1 mL/kg/h 4 h before and 20 h after CAG/PCI	Iopromide	136.40 ± 68.57 130.13 ± 63.79	CAG/ PCI	CI-AKI 1	eGFR of ≤ 60 mL/min/1.73 m². (mean eGFR 51.28 ± 5.03)	CIN,SCr, eGFR, and Cys-C
Ye et al. 2017 [37], (n = 106)	63.2(8.3)/65.3 (8.7)	NA	100/100	79.63/61.54	NA	20 mg, TDS at 48 h before and 24 h after CAG/PCI	1 to 1.5 mL/kg/hr 3 to 12 h before and up to 12 h after CAG/PCI	Iodixanol (non-ionic osmotic CM)	NA	CAG / PCI	CI-AKI 2	eGFR of 30 to 89 mL/min/1.73 m²	CIN, SCr, Cys-C, and eGFR
Ibrahim et al. 2017 [38] (n = 100)	64.83(7.36)/ 62.88(8.30)	1.56(0.22)/1.57 (0.24)	52/62	60/68	51.22(6.50)/51.96 (9.99)	35 mg BID for 72 h starting 48 h before and 24 h post-procedure	1 ml/kg/hr starting 12 h before and up to 12 h after CAG/PCI	Iopromide/ Iodixanol	112.80 ± 67.52 /124.40 ± 40.01	CAG / PCI	CI-AKI 3	CrCl of 30-90 ml/min	CIN, SCr and CrCl
Liu et al. 2015 [39] (n = 132)	59.0(11.2)/58.3(10.7)	107.74 (24.03)/103.38 (19.43)	61.3/60	54.8/54.3	NA	20 mg TDS 48 h before and 24 h after CAG/PCI	1 to 1.5 mL/kg/hr starting 3 to 12 h before and up to 12 h after CAG/PCI	Iodixanol (iso-osmolar, nonionic CM)	124.94 6 31.65/119.69 6 34.28	CAG/PCI	CI-AKI 1	eGFR 30–89 mL/min31.73 m²	CIN, SCr, and Cys-C,
Shehata et al. 2014 [40] (n = 100)	58 (6)/59(5)	2(0.5)/2(0.4)	100/100	46/50	54(8)/55(7)	35 mg BID for 72 h starting 48 h before the procedure and 24 h after PCI	1 ml/kg/hr starting 12 h before PCI and up to 24 h after PCI	Iopramide (non-ionic, low osmolar CM)	270 ± 10/ 280 ± 15	Elective PCI	CI-AKI 4	CrCl of 30- 90 mL/min	CIN, eGFR, and SCr
Rahman et al. 2012 [41] (n = 400)	56.5 (10.4)	1.39(0.23)/ 1.40(0.24)	None	72/86	NA	35 mg BID commencing 48 h pre-procedure, for 96 h	1 ml/kg/h for 12 h pre- and 12 h post-procedure	Iopramide (Low-osmolar CM)	95.34 ± 4.25/97.45 ± 5.62	CAG	CI-AKI 5	SCr level (1.2- 2.5) mg/dL	CIN and SCr
Onbasili et al. (n = 82) [42]	61(10)/60(11)	116.4 (22.8)/ 111.9 (14.9	20/26	100/100	48 (20) 47 (18)	20 mg TDS for 72 h starting 48 h before the procedure	1 ml/kg/hr starting 12 h before and up to 12 h after CAG/PCI	Iopramide (nonionic, low osmolar CM)	225/240	CAG/PCI	CI-AKI 5	SCr level > 1.2 mg/dL or CrCl of < 50 mL/min	CIN, SCr, and CrCl

SD Standard deviation, TMZ Trimetazidine, RI Renal insufficiency, IV Intravenous, NS Normal saline, SCr Serum creatinine, LVEF Left ventricular ejection fraction, DM Diabetes mellitus, HTN Hypertension, TID Three times per day, CAG Coronary angiography, PCI Percutaneous coronary intervention, CI-AKI Contrast-induced acute kidney injury, eGFR Estimated glomerular filtration rate, Cys-C Cystatin C, BID Twice per day, uNGAL Neutrophil Gelatinase-Associated Lipocalin, CM Contrast media, CI-AKI 1 an increase of 25% or more, or an absolute increase of 0.5 mg/dL or more in Scr from baseline value, at 48 to 72 h after the exposure to CM, CI-AKI 2 impairment of renal function as determined by a 25% increase in Scr from baseline or a 0.5 mg/dL increase in the absolute value within 48 after exposure to CM, CI-AKI 3 an absolute increase in SCr of 0.5 mg/dl, or a relative increase of 25% in SCr or CrCl at 24 or 72 h after the procedure compared to the baseline level, CI-AKI 4 an absolute increase of at least 0.5 mg/dl or a relative increase of at least 25% in the SCr level recorded after PCI, compared with the baseline value, CI-AKI 5 Increase in S. Creat. ≥ 0.5 mg/dL (44 µmol/L) or > 25% increase above baseline within 24-48 h

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