Inorganic nitrate reduces contrast-induced nephropathy (CIN), improves renal outcomes and reduces cardiac events compared to placebo in patients at risk of renal injury undergoing coronary angiography for acute coronary syndrome, according to late breaking research presented in a Hot Line session today at ESC Congress 2023.
CIN is associated with longer hospital stays, an increased risk of myocardial infarction and higher mortality. ESC guidelines highlight that patients with chronic kidney disease have been excluded from randomized trials on myocardial revascularization and that additional randomized evidence is needed on optimal strategies for CIN prevention.
Research has suggested that nitric oxide is deficient in CIN; therefore, strategies to replace nitric oxide might be of benefit. Inorganic nitrate is metabolized in the body to deliverto areas of the body in need and has shown renoprotective effects in preclinical studies. The NITRATE-CIN trial examined the efficacy of inorganic nitrate for the prevention of CIN in patients with non-ST elevation
referred for invasive coronary angiography and at risk of CIN. Risk of CIN was defined as an estimated glomerular filtration rate The primary endpoint was the incidence of CIN , as defined by the Kidney Disease Improving Global Outcomes criteria for acute kidney injury. Secondary outcomes included renal function at 3 months, rates of procedural myocardial infarction and major adverse cardiac events at 12 months.
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