The role of pentoxifylline in preventing contrast-induced nephropathy in coronary angiography/intervention – systematic review, meta-analysis, and meta-regression of randomized controlled trials

J.W. Martha, R. Pranata, W.M. Raffaello, A. Wibowo, M.R. Akbar

Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia. Jwmartha@gmail.com

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• Cardiovascular Diseases
• Pharmacology

OBJECTIVE: This systematic review and meta-analysis aimed to synthesize the latest evidence on pentoxifylline effect on the contrast-induced nephropathy (CIN) and whether the quality evidence is sufficient to make a definite conclusion

MATERIALS AND METHODS: We performed a systematic literature search on topics that assesses pentoxifylline and CIN in coronary angiography/intervention up until 01 April 2021 using PubMed, Scopus, Embase, and hand-sampling. Primary outcome was CIN defined as ≥0.5 mg/dL or 25% rise in the SCr 48 h after procedure.

RESULTS: There were a total of 1142 subjects from 6 studies. There was no difference between pentoxifylline and control group in terms of serum creatinine at baseline (p=0.46) and after the procedure (p=0.33). The incidence of CIN was 51/571 (8.9%) in the pentoxifylline group and 61/571 (10.7%) in the control group. Pentoxifylline was not significantly associated with increase or decrease in the risk of CIN (RR 0.84 [0.59, 1.19], p=0.32; I2: 0%, p=0.89). Subgroup analysis for elective studies showed a non-significant result (RR 0.77 [0.47, 1.27], p=0.31; I2: 0%). Meta-regression analysis showed that the association between pentoxifylline and mortality was not affected by age (p=0.994), gender (reference: male, p=0.562), hypertension (p=0.336), diabetes (p=0.536), baseline serum creatinine (p=0.344), contrast used (p=0.431), and CIN incidence (p=0.521). GRADE Approach showed a low certainty of evidence for the effect estimate of pentoxifylline on CIN.

CONCLUSIONS: Our meta-analysis showed that pentoxifylline was not associated with the risk of CIN with low certainty of evidence. Hence, larger, multicentre, double-blind randomized controlled trials are required.

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