Prevention of contrast-induced nephropathy with prostaglandin E1 in patients undergoing percutaneous coronary procedures: A meta-analysis of 24 randomized controlled trials
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BACKGROUND: Contrast-induced nephropathy (CIN) is the third most common cause of acute kidney injury in hospitalized patients. There have been many conflicting results across trials that have evaluated the prophylactic efficacy of prostaglandin E1 (PGE1) for prevention of CIN in patients undergoing percutaneous coronary procedures. PGE1 may have renal-protective effects due to its pleiotropic properties. The aim of this study was to evaluate the efficacy of PGE1 in preventing CIN. MATERIALS AND METHODS: We searched PubMed, Embase, Cochrane Library, Chinese Biomedical Literature, China National Knowledge Infrastructure, VIP Information/Chinese Scientific Journals, and WANFANG databases for randomized controlled trials (RCTs) comparing the preventive effects of PGE1 versus controls (conventional hydration, no PGE1, or placebo) on CIN in patients undergoing percutaneous coronary procedures from January 1999 to June 2016. Study characteristics and outcome data were abstracted by two independent reviewers; the risk of bias was also assessed by two reviewers. RESULTS: 24 RCTs involving 3,915 patients were included. Compared with controls, PGE1 reduced the risk of CIN (risk ratio: 0.40, 95% confidence interval (CI): 0.33, 0.48; p < 0.01). Serum creatinine levels in the PGE1 groups were significantly lower than in the control groups at 24, 48, and 72 hours after operation (mean difference (MD): -10.06, 95% CI: -16.94, -3.19; MD: -15.47, 95% CI: -21.75, -9.18; and MD: -11.15, 95% CI: -14.40, -7.91, respectively). Cystatin C was significantly lower for the PGE1 group than the control groups at 24, 48, and 72 hours after operation (MD: -0.24, 95% CI: -0.40, -0.07; MD: -0.34, 95% CI: -0.53, -0.14; and MD: -0.32, 95% CI: -0.49, -0.15, respectively). CONCLUSION: PGE1 may play an important role in reducing the incidence of CIN in patients undergoing percutaneous coronary procedures.
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