Brain natriuretic peptide for prevention of contrast-inducednephropathy: a meta-analysis of randomized controlled trials.

ABSTRACT

PURPOSE: 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 (I 2 = 0 %, p = 0.701; I 2 = 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 (I 2 = 0 %, RR = 0.39, 95 % CI 0.27-0.56, p < 0.001) or JADAD score > 3 (I 2 = 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.