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

Rezaei, Y and Rahimi, B and Khadem Vatani, K and Khoshfetrat, M and Seyyed Mohammadzadeh, M.H and Arjmand, N (2016) 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. J Am Heart Assoc, 5. pp. 1-12.

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Abstract

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 m2—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]9103/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

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