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Adenosine antagonists for prevention of contrast‑induced nephropathy: A meta‑analysis of randomized controlled trials with trial sequential analysis

  • Authors:
    • Hongbin Zang
    • Qiongyu Zhang
    • Xiaodong Li

  • View Affiliations

  • Published online on: May 9, 2019     https://doi.org/10.3892/etm.2019.7566
  • Pages: 85-98

  • Copyright: © Zang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Contrast‑induced nephropathy (CIN) is caused by intravascular administration of contrast agent. The efficacy of adenosine antagonists (AAs) in preventing CIN remains controversial, and its elucidation was the objective of the present meta‑analysis. A trial sequential analysis (TSA) to assess the reliability of the pooled results was also performed. The Medline, Embase, Web of Science and Cochrane databases were searched to retrieve all published randomized controlled trials (RCTs) comparing AAs with controls in preventing CIN. Heterogeneity, publication bias and quality of studies were assessed. Sensitivity, cumulative and subgroup analyses were also performed. The risk of random errors was evaluated by TSA. A total of 17 trials with 1,483 subjects were included. Pooled results indicated that AAs significantly reduced the incidence of CIN [risk ratio, 0.53; 95% confidence interval (CI), 0.29‑0.95; P=0.034] and the serum creatinine (SCr) level after contrast media (CM) administration (standardized mean difference, ‑0.24; 95% CI, ‑0.44 to ‑0.04; P=0.019). Meta‑regression did not identify any significant source of heterogeneity. In the subgroup analyses, AAs tended to exhibit a greater prevention efficacy in trials with sample sizes of ≥70, baseline SCr of <1.5 mg/dl and low study quality. TSA on the incidence of CIN indicated that the required information size determined as n=1,778 was not reached, and that the cumulative Z‑curve did not cross the TSA boundary. In conclusion, the present meta‑analysis of data from current RCTs suggested that AAs reduce the incidence of CIN and the SCr levels after CM administration. However, TSA showed that the risk of having a false‑positive result was greater than 5% in the meta‑analysis of the incidence of CIN, indicating that more evidence is required to ensure the benefit of AAs in preventing CIN.
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July-2019
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Spandidos Publications style
Zang H, Zhang Q and Li X: Adenosine antagonists for prevention of contrast‑induced nephropathy: A meta‑analysis of randomized controlled trials with trial sequential analysis. Exp Ther Med 18: 85-98, 2019.
APA
Zang, H., Zhang, Q., & Li, X. (2019). Adenosine antagonists for prevention of contrast‑induced nephropathy: A meta‑analysis of randomized controlled trials with trial sequential analysis. Experimental and Therapeutic Medicine, 18, 85-98. https://doi.org/10.3892/etm.2019.7566
MLA
Zang, H., Zhang, Q., Li, X."Adenosine antagonists for prevention of contrast‑induced nephropathy: A meta‑analysis of randomized controlled trials with trial sequential analysis". Experimental and Therapeutic Medicine 18.1 (2019): 85-98.
Chicago
Zang, H., Zhang, Q., Li, X."Adenosine antagonists for prevention of contrast‑induced nephropathy: A meta‑analysis of randomized controlled trials with trial sequential analysis". Experimental and Therapeutic Medicine 18, no. 1 (2019): 85-98. https://doi.org/10.3892/etm.2019.7566