@article {Sharpe000864, author = {Alexander J Sharp and Nishith Patel and Barney C Reeves and Gianni D Angelini and Francesca Fiorentino}, title = {Pharmacological interventions for the prevention of contrast-induced acute kidney injury in high-risk adult patients undergoing coronary angiography: a systematic review and meta-analysis of randomised controlled trials}, volume = {6}, number = {1}, elocation-id = {e000864}, year = {2019}, doi = {10.1136/openhrt-2018-000864}, publisher = {Archives of Disease in childhood}, abstract = {Objective Quantify the efficacy of strategies to prevent contrast-induced acute kidney injury (CI-AKI) in high-risk patients undergoing coronary angiography (CAG) with or without percutaneous coronary intervention (PCI).Background CI-AKI remains a common problem. The renoprotective efficacy of existing pharmacological agents remains uncertain in high-risk populations.Methods Systematic review and meta-analysis of randomised controlled trials (RCTs) to compare different strategies versus hydration in patients with chronic kidney disease (CKD) undergoing CAG{\textpm}PCI. Primary outcome was incident CI-AKI. Fixed-effects meta-analyses estimated ORs, 95\% CIs and heterogeneity.Results Forty-eight RCTs were included. Seven pharmacological strategies were evaluated by multiple RCTs and 10 by one RCT each. These had varying risk of bias; \>25\% of trials were at high risk of performance bias. Five strategies significantly reduced the odds of CI-AKI: N-acetylcysteine (NAC) (27 trials, 5694 participants; OR=0.77, 95\% CI 0.65 to 0.91, p=0.002, I2=36\%), ascorbic acid (four trials, 759 participants; OR=0.59, 95\% CI 0.39 to 0.89, p=0.01, I2=0\%), statin (two trials, 3234 participants; OR=0.59, 95\% CI 0.39 to 0.89, p=0.75, I2=0\%), trimetazidine (two trials, 214 participants; OR=0.27, 95\% CI 0.10 to 0.71, p=0.01, I2=0\%) and nicorandil (two trials, 389 participants; OR=0.47, 95\% CI 0.23 to 0.94, p=0.03, I2=52\%). Theophylline had a similar, but non-significant, effect. A subgroup analysis found that the benefit of NAC was highest in patients requiring a high-contrast dose.Conclusions Several drugs are renoprotective in patients with CKD undergoing CAG{\textpm}PCI. The evidence is strongest for NAC. We recommend that NAC should be used when a high dose of contrast is anticipated.Trial registration number PROSPERO registration CRD42014014704.Open Science Framework link: https://osf.io/vxg7d/?view_only=62bad0404b18405abd39ff2ead2575a8}, URL = {https://openheart.bmj.com/content/6/1/e000864}, eprint = {https://openheart.bmj.com/content/6/1/e000864.full.pdf}, journal = {Open Heart} }