Is there a European study demonstrating renal protection with intravenous (IV) nitroglycerin (glyceryl trinitrate) for patients undergoing cardiac catheterization?

From the Guidelines

There is no European study demonstrating renal protection with intravenous (IV) nitroglycerin (glyceryl trinitrate) for patients undergoing cardiac catheterization, as the provided evidence does not support this claim. The provided evidence [ 1 ] discusses the management of patients with unstable angina/non-ST-elevation myocardial infarction and the use of contrast media in coronary angiography, but it does not mention the use of IV nitroglycerin for renal protection in this context.

Key Points to Consider

• The evidence focuses on the importance of proper patient preparation with hydration and adjustment of maximal contrast dose to each patient's renal function and other clinical characteristics to protect patients undergoing cardiac catheterization [ 1 ].
• The use of sodium bicarbonate and N-acetylcysteine as adjunctive therapies to hydration has been studied, but the evidence is insufficient to recommend a specific regimen [ 1 ].
• The evidence emphasizes the need for renal-function–specific limits on maximal contrast volumes to minimize the risk of contrast-induced nephropathy [ 1 ].

Implementation in Clinical Practice

In the absence of evidence supporting the use of IV nitroglycerin for renal protection, clinicians should focus on established strategies for minimizing the risk of contrast-induced nephropathy, including:

• Proper patient preparation with hydration
• Adjustment of maximal contrast dose to each patient's renal function and other clinical characteristics
• Monitoring of renal function and blood pressure during and after the procedure By prioritizing these evidence-based strategies, clinicians can help reduce the risk of renal complications in patients undergoing cardiac catheterization.

From the Research

Renal Protection with Intravenous Nitroglycerin

• There are no research papers provided that directly demonstrate renal protection with intravenous (IV) nitroglycerin (glyceryl trinitrate) for patients undergoing cardiac catheterization 2, 3, 4, 5, 6.
• The studies provided focus on the use of N-acetylcysteine or ascorbic acid to prevent contrast-induced nephropathy or acute kidney injury in patients undergoing cardiac catheterization 2, 3, 4, 6.
• One study examines the plasma concentrations and hemodynamic effects of intravenous, sublingual, and aerosolized nitroglycerin in patients undergoing cardiac catheterization, but does not address renal protection 5.

Studies on Contrast-Induced Nephropathy

• A study published in 2003 found that oral acetylcysteine does not protect renal function from moderate to high doses of intravenous radiographic contrast 2.
• Another study published in 2003 found that N-acetylcysteine prevents reduction of renal function after coronary angiography, with a greater benefit in patients with baseline serum creatinine > 2 mg/dl 3.
• A randomized controlled trial published in 2004 found that intravenous N-acetylcysteine was ineffective in preventing contrast-induced nephropathy after cardiac catheterization 4.
• A study published in 2013 found that standard doses of N-acetylcysteine and ascorbic acid did not prevent contrast-induced acute kidney injury in patients at high risk undergoing cardiac catheterization 6.