Meta-analysis on allopurinol preventive intervention on contrast-induced acute kidney injury with random controlled trials PRISMA

Abstract

Objectives: The objective of this meta-analysis on randomized controlled trials is to evaluate whether the administration of allopurinol with or without hydration will reduce contrast-induced acute kidney injury (CI-AKI) in patients undergoing contrast exposure. Background: The efficacy of allopurinol in the prevention of CI-AKI after cardiac catheterization and percutaneous coronary intervention (PCI) is significantly related to the heterogeneous results. Methods: Two investigators independently searched MEDLINE, EMBASE, the Cochrane Controlled Trials Registry, the China Wanfang Data, the China Biological Medicine Database and the China National Knowledge Infrastructure (CNKI) databases for randomized controlled trials (RCTs) comparing allopurinol with placebo or no allopurinol for the prevention of CI-AKI in patients from their inception to July 31, 2018. The primary outcome was the incidence of CI-AKI, and the secondary outcomes were the differences of serum creatinine (Scr), blood urea nitrogen (BUN), uric acid (UA), and estimated glomerular filtration rate (eGFR) levels between groups after contrast media exposure. We used fixed-effects or random-effects models according to I2 statistics. The meta-analytic procedures were completed by Review Manager, version 5.3. Achievements: Eight random controlled trials with 1141 patients were included for this analysis. Compared with the control, allopurinol was associated with a reduced risk of CI-AKI (Relatives Risk (RR) 0.39, 95% confidence interval [CI] 0.20,0.74, P = .004) and only a intend for decrease a post-procedure uric acid levels compared with the controlled ones at 48 hours (standardized mean difference (SMD) -0.72, 95% CI -1.44, 0.01, P = .05). But the difference of post-procedure uric acid levels was not statistically significant in allopurinol groups compared with controlled groups. There were lower post-procedure Scr and BUN levels in allopurinol groups than those in controlled groups (SMD -0.50, 95% CI -0.79,-0.21, P = .0009; SMD -0.40, 95% CI -0.60,-0.20, P < .0001;respectively). There were higher post-procedure eGFR levels in allopurinol groups than those in controlled groups (SMD 0.65, 95% CI 0.48, 0.83, P < .0001). Conclusion: The main findings of this meta-analysis are focus on allopurinol may cause reduces in the incidence of CI-AKI in patients undergoing interventional coronary procedures. Further researches are still required for confirmation.