Evidence map›Paper›PMID 39548033›Full record

SynthesisInternational urology and nephrology2025

Preventive effects of nitric oxide donors in contrast-induced nephropathy in patients undergoing coronary artery angiography: an updated systematic review and meta-analysis of 13 randomized controlled trials.

Ahmed A Ibrahim, Shehroze Tabassum, Mohamed Abuelazm, Ahmed Mazen Amin, Mohamed Saad Rakab, Mohamed Rifai, AlMothana Manasrah, Abdelrahman Mahmoud, Ahmed Gaber Emara, Basel Abdelazeem and 3 more

Abstract readSystematic ReviewMeta-Analysis
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In one paragraph

Synthesis in International urology and nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Ahmed A IbrahimFaculty of Medicine, Menoufia University, Menoufia, Egypt.
Shehroze TabassumDepartment of Medicine, King Edward Medical University, Lahore, Pakistan.
Mohamed AbuelazmFaculty of Medicine, Tanta University, Tanta, Egypt.
Ahmed Mazen AminFaculty of Medicine, Mansoura University, Mansoura, Egypt.
Mohamed Saad RakabFaculty of Medicine, Mansoura University, Mansoura, Egypt.
Mohamed RifaiFaculty of Medicine, Menoufia University, Menoufia, Egypt. Mohamed.Ali181@med.menofia.edu.eg.ORCID http://orcid.org/0009-0007-9457-9832
AlMothana ManasrahInternal Medicine Department, UHS-Wilson Medical Center, Binghamton, NY, USA.
Abdelrahman MahmoudFaculty of Medicine, Minia University, Minia, Egypt.
Ahmed Gaber EmaraDepartment of Cardiology, Menoufia University, Menoufia, Egypt.
Basel AbdelazeemDepartment of Cardiology, West Virginia University, Morgantown, WV, USA.
Muner M B MohamedDepartment of Nephrology, Ochsner Health System, New Orleans, LA, USA.
Arvind KunadiNephrology Section, Department of Internal Medicine, McLaren Health Care, Flint, MI, USA.
Irfan ZebDepartment of Cardiology, West Virginia University, Morgantown, WV, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundContrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). We aimed to assess the latest evidence on the preventive effects of nitric oxide (NO) donors in CIN patients undergoing CAG/PCI.

methodsWe conducted a comprehensive systematic review and meta-analysis of RCTs from PubMed, Web of Science, Scopus, Embase, and Cochrane searches until May 5th, 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using (R version 4.3).

resultsOur analysis included 13 RCTs encompassing 3,550 patients. NO donors were significantly associated with a decreased incidence of CIN compared to placebo either as an oral administration (RR: 0.33 with 95% CI [0.26, 0.42], P < 0.01) or IV infusions (RR: 0.56 with 95% CI [0.40, 0.78], P < 0.01). Moreover, NO donors were significantly associated with decreased serum creatinine levels compared to placebo either as an oral administration (MD: - 0.07 with 95% CI [- 0.10, - 0.04], P < 0.01) or IV infusions (MD: - 0.07 with 95% CI [- 0.09, - 0.04], P < 0.01). In terms of safety, NO donors were significantly associated with a decreased incidence of major adverse cardiac events (MACE) compared to placebo as an oral administration (RR: 0.64 with 95% CI [0.45, 0.89], P < 0.01). However, there was no significant difference between NO donors as IV infusions and placebo in MACE (RR: 0.68 with 95% CI [0.38, 1.21], P = 0.18). Finally, NO donors were significantly associated with a decreased incidence of all-cause mortality compared to placebo as an oral administration (RR: 0.58 with 95% CI [0.36, 0.94], P = 0.03). Nevertheless, there was no statistically significant difference in all-cause mortality between IV infusions of NO donors and placebo (RR: 1.84 with 95% CI [0.40, 8.52], P = 0.44).

conclusionNO donors as adjunct therapy are associated with reduced incidence of CIN and decreased serum creatinine levels, either as an oral or IV administration. They were also associated with reduced incidence of MACE, all-cause mortality, and recurrent myocardial infarction as an oral administration, which makes this simple, low-cost intervention an important therapeutic option in patients undergoing CAG/PCI.

Indexed as

Contrast MediaCoronary AngiographyKidney DiseasesNitric Oxide DonorsHumansRandomized Controlled Trials as TopicContrast MediaNitric Oxide DonorsAnalysisCINContrastNitratesPCIReview

Identifiers

PMID39548033

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.