title: Efficacy of vitamin E and N-acetylcysteine in the prevention of contrast induced kidney injury in patients with chronic kidney disease: a double blind, randomized controlled trial.
abstract: BACKGROUND
  Contrast induced acute kidney injury is one of the most frequent causes of hospital acquired acute kidney injury. The present study aims to investigate the efficacy of vitamin E or N-acetylcysteine as an adjunct to current standard therapy in the prevention of this clinical predicament. We tested the hypothesis that vitamin E or N-acetylcysteine added to standard therapy with 0.45 % saline is superior in preserving renal function in patients with chronic kidney disease stage 1-4 undergoing elective computer-assisted tomography with nonionic radiocontrast agents when compared to 0.45 % saline alone.
  
  
  METHODS
  Prospective, randomized, single-center, double-masked, double dummy, placebo-controlled, parallel clinical trial.
  
  
  METHODS
  The patients were randomized to either vitamin E (total dose 2160 mg i.v.) or N-acetylcysteine (total dose 4800 mg p.o.) in addition to 0.45 % saline (1 mL/kg/h over 24 h) or saline alone. Serum creatinine change between baseline and 24 h after radiocontrast was the primary outcome. Contrast induced acute kidney injury was defined as a rise in serum creatinine > 25 % over the baseline value within 48 h.
  
  
  RESULTS
  Thirty patients (mean age 74.6 years; 17 females; 9 diabetics; all Caucasians; mean serum creatinine 1.35 mg/dL; mean creatinine clearance 56 mL/min) were enrolled. No patient developed contrast induced acute kidney injury. There was no significant difference in serum creatinine change between the three study arms.
  
  
  CONCLUSIONS
  Following radiocontrast administration, neither vitamin E nor N-acetylcystein in addition to saline demonstrated an additional beneficial effect on kidney function when compared to saline alone.
authors.affiliation: Department of Human Genetics, The Research Institute of the McGill University Health Centre at The Montreal Children's Hospital, McGill University, H3Z 2Z3, Montreal, QC, Canada.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kitzler
authors.forename: Aala
authors.initials: A
authors.lastname: Jaberi
authors.forename: Gerald
authors.initials: G
authors.lastname: Sendlhofer
authors.forename: Peter
authors.initials: P
authors.lastname: Rehak
authors.forename: Christian
authors.initials: C
authors.lastname: Binder
authors.forename: Eva
authors.initials: E
authors.lastname: Petnehazy
authors.forename: Rudolf
authors.initials: R
authors.lastname: Stacher
authors.forename: Peter
authors.initials: P
authors.lastname: Kotanko
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control*; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D016166:Free Radical Scavengers / Q000008:administration & dosage; D006801:Humans; D007472:Iohexol / Q000009:adverse effects / Q000031:analogs & derivatives*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D016896:Treatment Outcome; D014810:Vitamin E / Q000008:administration & dosage*
chemical_list: D003287:Contrast Media; D016166:Free Radical Scavengers; D014810:Vitamin E; D007472:Iohexol; C038192:iopromide; D000111:Acetylcysteine