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
BackgroundContrast 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 angiogr...
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| Format: | Article |
| Language: | English |
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Wiley
2016-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.115.002919 |
| _version_ | 1819178634287513600 |
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| author | Yousef Rezaei Kamal Khademvatani Behzad Rahimi Mehran Khoshfetrat Nasim Arjmand Mir‐Hossein Seyyed‐Mohammadzad |
| author_facet | Yousef Rezaei Kamal Khademvatani Behzad Rahimi Mehran Khoshfetrat Nasim Arjmand Mir‐Hossein Seyyed‐Mohammadzad |
| author_sort | Yousef Rezaei |
| collection | DOAJ |
| description | BackgroundContrast 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 ResultsIn 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]×103/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. ConclusionsProphylactic 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 RegistrationURL: https://www.clinicaltrials.gov/. Unique identifier: NCT02070679. |
| first_indexed | 2024-12-22T21:45:40Z |
| format | Article |
| id | doaj.art-161b6fa2852a4ad490ba208e94e8f737 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T21:45:40Z |
| publishDate | 2016-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-161b6fa2852a4ad490ba208e94e8f7372022-12-21T18:11:30ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-03-015310.1161/JAHA.115.002919Short‐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 TrialYousef Rezaei0Kamal Khademvatani1Behzad Rahimi2Mehran Khoshfetrat3Nasim Arjmand4Mir‐Hossein Seyyed‐Mohammadzad5Seyyed‐al‐Shohada Heart Center, Urmia University of Medical Sciences, Urmia, IranDepartment of Cardiology, Seyyed‐al‐Shohada Heart Center, Urmia University of Medical Sciences, Urmia, IranDepartment of Cardiology, Taleghani Hospital, Urmia University of Medical Sciences, Urmia, IranDepartment of Cardiology, Seyyed‐al‐Shohada Heart Center, Urmia University of Medical Sciences, Urmia, IranSeyyed‐al‐Shohada Heart Center, Urmia University of Medical Sciences, Urmia, IranDepartment of Cardiology, Seyyed‐al‐Shohada Heart Center, Urmia University of Medical Sciences, Urmia, IranBackgroundContrast 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 ResultsIn 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]×103/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. ConclusionsProphylactic 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 RegistrationURL: https://www.clinicaltrials.gov/. Unique identifier: NCT02070679.https://www.ahajournals.org/doi/10.1161/JAHA.115.002919chronic kidney diseasecontrast‐induced acute kidney injurycoronary angiographyvitamin E |
| spellingShingle | Yousef Rezaei Kamal Khademvatani Behzad Rahimi Mehran Khoshfetrat Nasim Arjmand Mir‐Hossein Seyyed‐Mohammadzad 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 Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease chronic kidney disease contrast‐induced acute kidney injury coronary angiography vitamin E |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | chronic kidney disease contrast‐induced acute kidney injury coronary angiography vitamin E |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.115.002919 |
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