Comparison of double-dose vs. usual dose of nicorandil for the prevention of contrast-induced nephropathy after cardiac catheterization.

PURPOSE

Contrast-associated nephropathy (CIN), the third main reason of the acute kidney injury (AKI) in inpatients, is a potentially severe side effect of angiography and the preventive role of nicorandil on CIN is still controversal. The aim of this clinical trial was to evaluate the preventive role of different doses of nicorandil on CIN in patients experiencing cardiac catheterization compared with hydration.

METHODS

We recorded outcomes from 330 patients who were randomly divided to either a double-dose (30 mg/day) nicorandil group or to a usual-dose (15 mg/day) nicorandil group or a control group (hydration only). The primary endpoint of the current research was the occurrence of CIN, which is defined as a relative elevation of SCr level of 25% above the baseline or an absolute increment of SCr of more than 44.2 µmol/L (0.5 mg/dL) within 48 or 72 h after contrast medium exposure. Additional endpoints were the changes in BUN, SCr, Cys-C, eGFR, and CRP level within 48 h after contrast agent exposure and major adverse events occurring during hospitalization and 14 days of follow-up.

RESULTS

6 out of 111 patients (5.4%) had contrast-induced nephropathy in the double-dose group and it occured 11 out of 107 patients (10.3%) in the usual-dose group, 16 out of 112 patients (14.3%) in the control group. There was a significant difference in the occurrence of CIN between the double-dose group and the control group at 48 h after taking the radiocontrast medium (p = 0.026) while no such significant difference observed in the usual-dose group and the control group (p = 0.367), the double-dose group and usual-dose group (p = 0.180) as well.

CONCLUSIONS

Daily peri-procedural usual-dose nicorandil could just relieve contrast-induced renal injury, only double-dose nicorandil was associated with a reduced incidence of CI-AKI compared with hydration.