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

Yousef Rezaei, Kamal Khademvatani, Behzad Rahimi, Mehran Khoshfetrat, Nasim Arjmand, Mir-Hossein Seyyed-Mohammadzad, Yousef Rezaei, Kamal Khademvatani, Behzad Rahimi, Mehran Khoshfetrat, Nasim Arjmand, Mir-Hossein Seyyed-Mohammadzad

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.

Keywords: chronic kidney disease; contrast‐induced acute kidney injury; coronary angiography; vitamin E.

© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1
Figure 1
Flow diagram of patient selection.
Figure 2
Figure 2
Change in serum creatinine (A), eGFR (B), and WBC count (C) in vitamin E and placebo groups. eGFR indicates estimated glomerular filtration rate; WBC, white blood cell.
Figure 3
Figure 3
Incidence of CIAKI in the subgroups (A) without history of preoperative statin use and (B) with history of preoperative statin use, divided by treatment groups. CIAKI indicates contrast medium–induced acute kidney injury.
Figure 4
Figure 4
Incidence of CIAKI in the vitamin E and placebo groups based on baseline Mehran risk score in all patients, divided by treatment groups. None of paired comparisons were statistically significant. CIAKI indicates contrast medium–induced acute kidney injury.

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