The Effect Of Alprostadil On The Prevention Of Contrast-induced Nephropathy In Patients Undertaking Coronary Intervention: A Systematic Review And Meta-analysis

Background:With the fast development of coronary intervention technology and more widely used contrast media.Contrast-induced nephropathy is the third most common cause of hospital-acquired renal failure. Numerous risk factors for CIN have been identified,including old age, uncontrolled blood pressure,impaired glucose tolerance, over use of contrast media giving high pressure on the renal loading.Basic chemical experimentations have proved that aloprostadil has the ability to anti-inflammatory response,antigen- antibody reaction, diastolic the vascular smooth muscle,protect the cell endothelium.Whether short-term alprostadil could be uesd on the prevention of contrast-induced nephropathy in patients undertaking coronary intervention is still unknown.Our aim is to take the advantage of the knowledge of evidence-based medicine,retrieval recently published randomized controlled trials about alprostadil on the prevention of contrast-induced nephropathy and discuss the effect of alprostadil.Methods:We conducted a comprehensive search of Wang Fang, CNKI,Pub Med,EMBASE and the Cochrane Library databases to obtain RCTs published up to March 2016 with the key words alprostadi/prostaglandin E1、 contrast 、 nephropathy/nephrosis/nephrotoxicity / kidney failure in all language that assess the prevention effects of Alprostadi on CIN.Data extraction,study selection and methodological quality of the evaluated independently by two investigators.The methodological quality of the RCT s was assessed using the 7-point scale developed by Jadad et al.Pooled data were estimated using random effect model.All data analysis was conducted using Rev Man analyses software(Rev Man 5.2).Results:Eight trials with a total of 1391 patients were identified.Analysis of the data in patients revealed significant differences in CIN incidence between the Alprostadil group and the placebo group(4.4% vs 13.8%).The relative risk[RR=0.32,95%CI(0.22,0.48),P<0.000 01 ] was without evidence of heterogeneity(I2=0,P<0.05).48 h levels of Scr[MD =-5.19,95%CI(-8.73,-1.65),P=0.004], 72 h Scr[MD=-8.20,95%CI(-13.09,-3.30).P=0.001],48 h BUN[MD=-1.02,95%CI(-1.65,-0.39),P=0.001],72 h BUN[MD=-0.68,95%CI(-1.30,0.06),P=0.03]were significantly lower than in placebo group after PCI(P<0.05).Conclusion:Short-term used of Alprostadil may be beneficial in reducing the incidence of CIN and protect the renal function in patients undergoing coronary angiography intervention.