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

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