Division of Nephrology, Nephrology Institute of PLA, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
Am J Kidney Dis. 2012 Sep;60(3):360-70. doi: 10.1053/j.ajkd.2012.02.332. Epub 2012 Apr 17.
Whether treatment with adenosine receptor antagonists such as theophylline can prevent contrast-induced acute kidney injury (AKI) remains controversial.
We conducted a meta-analysis of randomized controlled trials using MEDLINE (1966 to July 2011), EMBASE (1980 to July 2011), Web of Science (1986 to July 2011), and the Cochrane Central Register of Controlled Trials (1996 to July 2011), without language restriction.
SETTING & POPULATION: Patients undergoing contrast procedures.
Randomized controlled trials assessing adenosine antagonists versus control for prevention of contrast-induced AKI.
Adenosine antagonists with or without N-acetylcysteine versus control with or without N-acetylcysteine.
Contrast-induced AKI, change in serum creatinine level, requirement of dialysis, and in-hospital mortality.
16 trials (1,412 participants) were included. Theophylline significantly decreased the risk of contrast-induced AKI (13 trials, 1,222 patients; risk ratio, 0.48; 95% CI, 0.26-0.89; P = 0.02; I(2) = 45%) and had a protective effect on the absolute change in serum creatinine concentration (13 trials, 1,170 patients; standardized mean difference, -0.31 mg/dL; 95% CI, -0.50 to -0.11; P = 0.002; I(2) = 60%). Meta-regression showed a significant relation between the relative risk of contrast nephropathy and baseline serum creatinine level or Jadad score. No clear effects of treatment on risk of dialysis and in-hospital mortality were identified.
Power to assess clinical end points was limited.
Theophylline treatment significantly reduced the incidence of contrast-induced AKI and had a modest improvement on kidney function after contrast exposure in the general population. However, beneficial effects of theophylline were not observed in patients with high baseline creatinine values (serum creatinine ≥1.5 mg/dL). In addition, the long-term effect of this agent on more clinically important outcomes was not established. Future large-scale high-quality multicenter trials in participants with different underlying risks of contrast-induced AKI and that incorporate the evaluation of clinically relevant outcomes are required.
腺苷受体拮抗剂（如茶碱）治疗能否预防对比剂诱导的急性肾损伤（AKI）仍存在争议。
我们对 MEDLINE（1966 年至 2011 年 7 月）、EMBASE（1980 年至 2011 年 7 月）、Web of Science（1986 年至 2011 年 7 月）和 Cochrane 对照试验中心注册库（1996 年至 2011 年 7 月）进行了荟萃分析，未设语言限制。
接受对比检查的患者。
评估腺苷拮抗剂与对照药物预防对比剂诱导 AKI 的随机对照试验。
腺苷拮抗剂联合或不联合 N-乙酰半胱氨酸与对照组联合或不联合 N-乙酰半胱氨酸。
共纳入 16 项试验（1412 例患者）。茶碱显著降低对比剂诱导 AKI 的风险（13 项试验，1222 例患者；风险比，0.48；95%可信区间，0.26-0.89；P = 0.02；I(2) = 45%），并对血清肌酐浓度的绝对变化有保护作用（13 项试验，1170 例患者；标准化均数差，-0.31mg/dL；95%可信区间，-0.50 至 -0.11；P = 0.002；I(2) = 60%）。元回归显示，对比性肾病的相对风险与基线血清肌酐水平或 Jadad 评分之间存在显著关系。未发现治疗对透析和住院死亡率风险的明显影响。
评估临床终点的效能有限。
茶碱治疗可显著降低对比剂诱导的 AKI 发生率，并在一般人群中改善对比暴露后的肾功能。然而，在基线肌酐值较高（血清肌酐≥1.5mg/dL）的患者中，茶碱的有益作用并不明显。此外，该药物对更具临床意义的结局的长期影响尚未确定。需要在具有不同对比剂诱导 AKI 风险的参与者中进行大规模、高质量、多中心试验，并纳入对临床相关结局的评估。
