Onbasili AO et al. (2007) Trimetazidine in the prevention of contrast-induced nephropathy after coronary procedures. Heart 93: 698–702

Contrast-induced nephropathy (CIN), a serious complication of coronary angiography, is particularly common in patients with renal insufficiency. Hydration with isotonic saline is the only generally accepted way of preventing CIN at present. As formation of oxygen free radicals and renal medullar ischemia are thought to be involved in the pathogenesis of CIN, Onbasili et al. investigated whether administration of trimetazidine, an agent with anti-ischemic and antioxidant properties, might be a useful adjunct to isotonic saline.

The study enrolled 82 patients with mild renal insufficiency who underwent coronary procedures. Patients were randomly assigned to a trimetazidine group (20 mg thrice daily orally for 72 h starting 48 h before the procedure; n = 40) or a control group (n = 42). All patients received standard parenteral hydration (isotonic saline 1 ml/kg/h from 12 h before the procedure to up to 12 h after). The same contrast agent—iopromide—was used in all patients.

CIN (defined as an absolute serum creatinine increase of 44 µmol/l [0.5 mg/dl] or a relative increase of 25% from baseline 1–2 days after the procedure) was significantly more common in controls than in trimetazidine-treated patients (16.6% vs 2.5%; P <0.05). In controls, serum creatinine levels were higher and creatinine clearances were lower 2 days after the procedure than at baseline; these parameters returned to baseline levels by day 7. By contrast, no changes from baseline in serum creatinine levels or creatinine clearances were seen on day 2 in trimetazidine-treated patients, and by day 7 these patients actually had decreased serum creatinine levels and increased creatinine clearances. No trimetazadine-related adverse effects were noted.