Protection of radiocontrast induced nephropathy by vitamin E (alpha tocopherol): a randomized controlled pilot study.
BACKGROUND
Contrast-induced nephropathy (CIN) increases the likelihood of patient morbidity and mortality following coronary procedures. Contrast agents cause an acute deterioration in renal function via the generation of reactive oxygen species. The present study was designed to evaluate the administration of antioxidant vitamin E (alpha tocopherol) as a means of preventing CIN in these patients.


METHODS
The authors conducted a prospective, double-blind, randomized and placebo-controlled trial in 103 patients with serum creatinine (SCr) levels > or = 1.2 mg/dL, baseline creatinine clearance levels < or = 60 mL/min, and who had undergone coronary procedures. Alpha tocopherol (525 IU) or a placebo compound was administered orally at 48 hr, 24 hr, and in the morning prior to coronary procedures.


RESULTS
CIN developed in 3 of 51 patients (5.88%) in the alpha tocopherol group and 12 of 52 patients (23.08%) in the placebo group (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.05 to 0.79; p = 0.02). The mean SCr increased significantly in the placebo group (from 1.67 +/- 0.53 to 1.9 +/- 0.87 mg/dL, p = 0.02) but not in the alpha tocopherol group (from 1.62 +/- 0.44 to 1.64 +/- 0.59 mg/dL, p = 0.74). Patients with diabetes, anemia, or with contrast agent dosages greater than 120 ml exhibited significantly lower incidences of CIN development in the alpha tocopherol group than the placebo group (p < 0.05).


CONCLUSIONS
Prophylactic oral administration of alpha tocopherol is capable of protecting against CIN in patients with chronic kidney disease undergoing elective coronary procedures.
Tasanarong
Adis
A
Nephrology Unit, Department of Medicine, Faculty of Medicine, Thammasat University, Rangsit Campus, Pathumtani, Thailand. adis_tasanarong@hotmail.com
Piyayotai
Dilok
D
Thitiarchakul
Supachai
S
D000284:Administration, Oral; D000975:Antioxidants / Q000627:therapeutic use; D015897:Comorbidity; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology; D008297:Male; D010865:Pilot Projects; D011292:Premedication; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000139:chemically induced / Q000517:prevention & control*; D024502:alpha-Tocopherol / Q000627:therapeutic use*
D000975:Antioxidants; D003287:Contrast Media; D003404:Creatinine; D024502:alpha-Tocopherol