Short‐Term High‐Dose Vitamin E to Prevent Contrast Medium–Induced Acute Kidney Injury in Patients With Chronic Kidney Disease Undergoing Elective Coronary Angiography: A Randomized Placebo‐Controlled Trial. Issue 3 (15th March 2016)

• Record Type: Journal Article
• Authors: Rezaei, Yousef; Khademvatani, Kamal; Rahimi, Behzad; Khoshfetrat, Mehran; Arjmand, Nasim; Seyyed‐Mohammadzad, Mir‐Hossein
• Is Part Of: Journal of the American Heart Association. Volume 5:Issue 3(2016)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2016-03-15
• Subjects: chronic kidney disease -- contrast‐induced acute kidney injury -- coronary angiography -- vitamin E; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.115.002919
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : Background: Contrast medium–induced acute kidney injury (CIAKI) is a leading cause of acquired renal impairment. The effects of antioxidants have been conflicting regarding the prevention of CIAKI. We performed a study of vitamin E use to decrease CIAKI in patients undergoing elective coronary angiography. Methods and Results: In a placebo‐controlled randomized trial at 2 centers in Iran, 300 patients with chronic kidney disease—defined as estimated glomerular filtration rate <60 mL/min per 1.73 m 2 —were randomized 1:1 to receive 0.9% saline infusion 12 hours prior to and after intervention combined with 600 mg vitamin E 12 hours before plus 400 mg vitamin E 2 hours before coronary angiography or to receive placebo. The primary end point was the development of CIAKI, defined as an increase ≥0.5 mg/dL or ≥25% in serum creatinine that peaked within 72 hours. Based on an intention‐to‐treat analysis, CIAKI developed in 10 (6.7%) and 21 (14.1%) patients in the vitamin E and placebo groups, respectively ( P =0.037). Change in white blood cell count from baseline to peak value was greater in the vitamin E group compared with the placebo group (−500 [−1500 to 200] versus 100 [−900 to 600]×10 3 /mL, P =0.001). In multivariate analysis, vitamin E (odds ratio 0.408, 95% CI 0.170–0.982, P =0.045) and baseline Mehran score (odds ratio 1.257, 95% CI 1.007–1.569; P =0.043) predicted CIAKI. Conclusions: Prophylactic short‐term high‐dose vitamin E combined with 0.9% saline infusion is superior to placebo for prevention of CIAKI in patients undergoing elective coronary angiography. Clinical Trial Registration: URL:https://www.clinicaltrials.gov/ . Unique identifier: NCT02070679.