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Metoprolol, carvedilol and nebivolol were different beta blockers with different properties. In the literature there are various studies evaluating renal effects of these beta blockers under different conditions. However, to the best of our knowledge there is not any study comparing preventive effects of these three beta blockers with each other against contrast induced nephropathy (CIN).
We aimed to investigate and compare the probable prophylactic effects of three beta blocker agents, carvedilol, nebivalol and metoprolol against CIN.
184 patients who were hospitalized for further evaluation with coronary angiography and have been using beta blocker agent (50 mg metoprolol, 25 mg carvedilol or 5 mg nebivolol) at least for a week were enrolled to the study. Exclusion criteria included dialysis patients, recent exposure to contrastmedia or a nephrotoxic agent within 7 days before the study, urgent percutaneous coronary intervention (PCI), requiring loop diuretics, theophylline/ aminophylline, dopamine throughout the study, hemodynamically unstable patients. Patients were divided into three groups: metoprolol (M) (64 patient), nebivolol (N) (60 patient), carvedilol (C) (60 patient). All groups were hydrated before and after the coronary procedure for 12 hours with the rate of 1 ml/kg/hour intravenous isotonic saline. Serum cretainine (Cr) levels were checked in the second and fifth days of the study. The primary end point was the occurence of CIN. We defined CIN as an increase ≥0.5 mg/dL and/or ≥25% in serum creatinine (SCr) concentration at day 2 and/or day 5 of the procedure.
The distribution of various characteristics of the participants is shown in Table 1and Table 2. Seven (10.9%) patients in group M developed CIN, as did 5 patients (8.3%) in group N and 2 patients (3.3%) in group C. Patients in carvedilol group developed less CIN, however the difference with the group C and the others did not reach statistical significance (p=0.283) (Figure 1). Changes in mean Cr level from baseline to day 2 and day 5 were not statistically significant in all groups.
If there is indication for a beta blocker therapy before the coronary angiography procedure, although the comperative results with metoprolol and nebivolol did not reach statistical significance, this study demonstrated a weak evidence favouring against carvedilol prescription as it would be a better choice for the prevention of CIN.
|Male||38 (59.4%)a||21 (35%)b||32 (53.3%)a.b||0,02|
|Female||26 (40.6%)a||39 (65%)b||28 (46.7%)a.b||0.02|
|Diabetes Mellitus||17 (26.6%)||20 (33.3%)||14 (23.3%)||0.494|
|Hypertension||51 (79.7%)a||33 (55%)b||36 (60%)b||0.008|
|Hyperlipidemia||29 (45.3%)a||9 (15%)b||14 (23.3%)b||0.001|
|Family History of coronary heart disease||9 (14.1%)||3 (5%)||5 (8.3%)||0.228|
|Smoking||29 (45.3%)a||14 (23.3%)b||25 (41.7%)a.b||0.023|
|Statin||33 (51.6%)||25 (41.7%)||28 (46.7%)||0.532|
|ACE||27 (42.2%)||16 (26.7%)||16 (26.7%)||0.114|
|ARB||18 (28.1%)||14 (23.3%)||16 (26.7%)||0.871|
|Tiazide||5 (7.8%)||6 (10%)||6 (10%)||0.902|
|Trimetazidin||3 (4.7%)||4 (6.7%)||3 (5%)||0.925|
|Metformine||10 (15.6%)||12 (20%)||7 (11.7%)||0.466|
|CIN||7 (10.9%)||5 (8.3%)||2 (3.3%)||0.283|
Categorical distributions of various characteristics of the participants
|Total contrast dose ml||127.97±73.66a||99.67±39.44a||104.67±79.86b||0.009|
|Second day creatinine||0.92±0.26a||0.84±0.22a||0.82±0.17b||0.029|
|Fifith day creatinine||0.90±0.19a||0.81±0.20b||0.81±0.14b||0.008|
Numerical data of the distribution of various characteritics of participants