From the Guidelines
Intravenous nitroglycerin is not recommended for the prevention of contrast-induced nephropathy (CIN) due to lack of consistent evidence supporting its effectiveness. The 2014 ESC/EACTS guidelines on myocardial revascularization do not mention IV nitroglycerin as a recommended strategy for preventing CIN 1. Instead, the guidelines emphasize the importance of hydration with isotonic saline, use of low-osmolar or iso-osmolar contrast media, and minimizing contrast volume as key measures to prevent CIN. Some key recommendations include:
- Hydration with isotonic saline is recommended for patients with moderate-to-severe chronic kidney disease (CKD) 1
- Use of low-osmolar or iso-osmolar contrast media is recommended, with a suggested volume of less than 350 mL or less than 4 mL/kg, or a total contrast volume/GFR of less than 3.4 1
- Short-term, high-dose statin therapy should be considered for patients undergoing coronary angiography or MDCT 1 The primary pathophysiological mechanisms underlying CIN involve direct tubular toxicity and renal vasoconstriction, which IV nitroglycerin does not adequately address. While nitroglycerin is a vasodilator that theoretically could improve renal blood flow, clinical studies have yielded mixed results, with most showing no significant protective effect against CIN. Therefore, the routine use of IV nitroglycerin for preventing CIN is not supported by current evidence.
From the Research
Contrast-Induced Nephropathy Prevention
The provided studies do not specifically investigate the effect of intravenous (IV) nitroglycerin on contrast-induced nephropathy (CIN). However, they discuss various strategies for preventing CIN, including:
- Intravenous hydration with isotonic saline or sodium bicarbonate 2, 3, 4
- Use of N-acetylcysteine 2, 3
- Minimizing contrast media volume 3, 5
- Withdrawal of non-steroidal anti-inflammatory drugs 3
- Use of iso-osmolar or low-osmolar contrast media 3
Key Findings
Some key findings from the studies include:
- Intravenous hydration is effective in reducing the incidence of CIN in high-risk patients 6, 2, 4
- The addition of N-acetylcysteine or sodium bicarbonate to intravenous hydration may not have a significant effect on the incidence of CIN 2
- Minimizing contrast media volume and using iso-osmolar or low-osmolar contrast media may help reduce the risk of CIN 3, 5
Limitations
The studies provided do not investigate the specific effect of IV nitroglycerin on CIN. Therefore, there is no evidence to support or refute the use of IV nitroglycerin for preventing CIN 6, 2, 3, 5, 4