Prophylactic Administration of Oral Allopurinol with Standard IV Hydration in Preventing Contrast-Induced Nephropathy in Patients Undergoing Cardiac Catheterization: A Meta-Analysis and Systematic Review

ABSTRACT

@#BACKGROUND: Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality of patients. One of the mechanisms that have been investigated in the development of CIN is the presence of hyperuricemia. Thus, it has been postulated that using urate-lowering agents may be beneficial in preventing CIN. This report aims to determine the efficacy of giving allopurinol along with standard IV hydration in reducing the incidence of contrast-induced nephropathy after coronary catheterization. METHODS: We conducted as electronic search using PUBMED, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Kidney and Transplant register of Studies, Google Scholar, and Research Gate. Studies fulfilling the inclusion and exclusion criteria were quality assessed based on the criteria provided in the Cochrane Handbook for Systematic Reviews of Interventions. Only published full manuscripts written in English from 1966 to April 2018 were included. The incidences of CIN were analyzed using a random-effects model in Review Manager (Rev Man) Version 5.3 with a 95% confidence interval. RESULTS: Five studies of 2,033 were included with a total of 753 patients. Results showed that there is a 63% decrease in CIN [RR = 0.37 (0.25 to 0.54, 95% CI, Z = 5.10, p < 0.00001) in the allopurinol group compared to those who received hydration alone. When adjusted for heterogeneity by using the random effects model, there remains a 35% decrease in the incidence of CIN [RR = 0.65 (0.43 to 0.99, 95% CI, Z = 2.02, p = 0.04) in the allopurinol group. CONCLUSION: Allopurinol administration may be protective in the development of CIN in patients undergoing coronary interventions. However larger, multi-centered randomized-controlled trials are needed to validate this claim.