Nicorandil Reduces Risk of Contrast-Induced Nephropathy in Coronary Interventions: Study
Egypt: Researchers have found in a new study that Nicorandil was effective in lowering the incidence of contrast-induced nephropathy (CIN), limiting creatinine rise, and demonstrated a favorable safety profile in patients undergoing coronary procedures.
A systematic review and meta-analysis published in BMC Nephrology by Ahmed A. Abo Elnaga from the Faculty of Medicine at Mansoura University, Egypt, and colleagues, offers compelling evidence supporting Nicorandil’s role in kidney protection during cardiac interventions. CIN remains one of the most concerning complications following coronary angiography or percutaneous coronary intervention, particularly among patients with pre-existing renal impairment. The study aimed to clarify whether Nicorandil—a vasodilatory and cytoprotective agent—can mitigate this risk.
The research team conducted an extensive literature search across major scientific databases up to September 2024, focusing on randomized controlled trials evaluating Nicorandil’s effectiveness in preventing CIN during coronary procedures. A total of 11 trials involving 2,837 patients met the inclusion criteria.
The pooled results demonstrated a significant advantage of Nicorandil over standard management. Patients receiving the drug had a markedly lower risk of CIN, with a relative risk of 0.37—indicating a 63% reduction compared with control groups. Importantly, this finding showed no heterogeneity across studies, strengthening the reliability of the outcome.
Key Findings:
- Nicorandil consistently reduced the rise in serum creatinine levels at 24, 48, and 72 hours after the procedure, with decreases ranging from about 4.5 to 5.7 μmol/L, indicating meaningful short-term renal protection.
- No significant differences were observed between groups in estimated glomerular filtration rate (eGFR) during the first 72 hours, making its effect on overall renal filtration function unclear.
- The safety profile of Nicorandil remained strong, with similar rates of major adverse events—such as myocardial infarction, stroke, emergency PCI, or urgent dialysis—between the Nicorandil and control groups.
The findings suggests that the drug’s renoprotective benefits do not come at the cost of increased cardiovascular or procedural risks.
The authors noted key limitations, including inconsistent Nicorandil dosing, varied timing of administration, and differing CIN definitions across studies. These variations highlight the need for standardized dosing protocols and uniform diagnostic criteria in future research.
The study revealed that nicorandil appears to offer meaningful protection against CIN and provides renal benefits without increasing major complications in patients undergoing coronary interventions. The authors emphasize that larger, long-term studies are needed to determine optimal dosing schedules and compare Nicorandil directly with other commonly used preventive agents, such as statins and N-acetylcysteine.
Reference:
Abo Elnaga, A.A., Alawadi, I.S., Elettreby, A.M. et al. The protective effects of Nicorandil on renal function in patients undergoing coronary interventions: a systematic review and meta-analysis. BMC Nephrol 26, 680 (2025). https://doi.org/10.1186/s12882-025-04564-8
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