Oral Nicorandil attenuates contrast-induced nephropathy in patients undergoing cardiac catheterization

Contrast-induced nephropathy is defined as the impairment of kidney function, measured as either a 0.5 mg/dL (44 µmol/L) increase in absolute serum creatinine (SCr) value or a 25% increase in SCr from baseline within 48-72 hours after the administration of intravenous contrast. There has been a global increase in the incidence of CIN and can increase long-term problems and mortality rates.

Sadegh Alavi Babalhekam, Mashhad University of Medical Sciences, Mashhad, Iran, and colleagues, therefore, aimed to determine the effect of Nicorandil on preventing contrast-induced nephropathy among patients undergoing cardiac catheterization.

The controlled randomized open-labeled clinical trial included patients undergoing cardiac catheterization due to coronary problems and having at least two risk factors of contrast nephropathy. Patients were divided into two groups and 172 patients entered each group of intervention and control.

The intervention group received oral Nicorandil and normal saline, and the control group received intravenous normal saline. Serum creatinine measurement was done before and 48 hours after the procedure. Patients were evaluated for CIN.

The study led to the following findings:

• The incidence of CIN was meaningfully lower in the Nicorandil group (7%) than in the control group (19.8%).
• The incidence of CIN was notably lower in the female patients in the Nicorandil (85.7%) than in the control group (14.3%); however, these numbers were not significantly different among men (64.0% and 36.0%, respectively).
• After the injection of the contrast agent, the serum levels of blood urea nitrogen, creatinine, and glomerular filtration rate showed no significant differences between the control and Nicorandil groups.
• Multivariate regression analysis showed that Nicorandil significantly lowered the odds of CIN [odds ratio (OR) = 0.299] after adjustment for baseline creatinine (OR = 1.404).

"Our findings indicate that pre-procedural treatment with Nicorandil may be effective against contrast-induced nephropathy in contrast to agent-exposed patients," the researchers concluded.

Reference:

Abdollahi Moghaddam, A., Baradaran Rahimi, V., Morovatdar, N. et al. Oral Nicorandil effectively attenuates the incidence of contrast-induced nephropathy in patients undergoing cardiac catheterization: a randomized, controlled, open-label clinical trial. Int Urol Nephrol 55, 2327–2334 (2023). https://doi.org/10.1007/s11255-023-03541-0