title: Prevention of contrast-induced nephropathy with single bolus erythropoietin in patients with diabetic kidney disease: A randomized controlled trial.
abstract: OBJECTIVE
  Contrast-induced-nephropathy (CIN) is associated with poor outcomes, thus prevention of CIN may be of clinical value. Erythropoietin (EPO) has been shown to elicit tissue-protective effects in experimental models and in clinical studies of acute kidney injury. We therefore evaluated its effectiveness for prevention of CIN after coronary angiography (CA) ± percutaneous coronary intervention (PCI) in diabetic patients with chronic kidney disease.
  
  
  METHODS
  A prospective, randomized, controlled trial was carried out in 138 diabetic patients with eGFR <60 mL/min who underwent non-urgent CA ± PCI. Patients received normal saline and n-acetyl cysteine before CA, with or without 50,000 U of EPO administered 30 min prior to CA. CIN was defined as an increase in serum creatinine of at least 0.5 mg/dL during the first 2 days after exposure to contrast media. Primary outcome was the incidence of CIN. Secondary outcomes were the sensitivity and positive predictive value (PPV) of Cystatin C (CC) and Neutrophil-gelatinase-associated-lipocalin (NGAL) for diagnosis of CIN.
  
  
  RESULTS
  The observed incidence of CIN was 8.7%, significantly lower than the expected for such high-risk population. The administration of EPO prior to CA did not reduce the incidence of CIN (9.7% vs. 7.6%, P = 0.65). CC and NGAL demonstrated a low sensitivity (16.6%) and low PPV (6.7 and 33.3%, respectively) for detecting CIN.
  
  
  CONCLUSIONS
  The administration of EPO prior to CA did not reduce the incidence of CIN. Additional prospective research with a larger sample size and in other patient categories is essential to further define the potential protective effect of EPO on prevention of CIN.
authors.affiliation: Quality Assurance Department, Galilee Medical Center, Nahariya, Israel.
authors.forename: Lilach
authors.initials: L
authors.lastname: Shema-Didi
authors.affiliation: Nephrology Department, Galilee Medical Center, Nahariya, Israel.|Faculty of Medicine of the Galilee, Bar-Ilan University, Safed, Israel.
authors.forename: Batya
authors.initials: B
authors.lastname: Kristal
authors.affiliation: Cardiology Department, Galilee Medical Center, Nahariya, Israel.
authors.forename: Sarit
authors.initials: S
authors.lastname: Eizenberg
authors.affiliation: Cardiology Department, Galilee Medical Center, Nahariya, Israel.
authors.forename: Nabil
authors.initials: N
authors.lastname: Marzuq
authors.affiliation: Cardiology Department, Galilee Medical Center, Nahariya, Israel.
authors.forename: Majdy
authors.initials: M
authors.lastname: Sussan
authors.affiliation: Cardiology Department, Galilee Medical Center, Nahariya, Israel.
authors.forename: Yulie
authors.initials: Y
authors.lastname: Feldman-Idov
authors.affiliation: Cardiology Department, Galilee Medical Center, Nahariya, Israel.
authors.forename: Pnina
authors.initials: P
authors.lastname: Ofir
authors.affiliation: Cardiology Department, Galilee Medical Center, Nahariya, Israel.|Faculty of Medicine of the Galilee, Bar-Ilan University, Safed, Israel.
authors.forename: Shaul
authors.identifier: http://orcid.org/0000-0002-5097-5100
authors.initials: S
authors.lastname: Atar
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood / Q000652:urine; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D055316:Cystatin C / Q000097:blood; D019610:Cytoprotection; D003928:Diabetic Nephropathies / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007472:Iohexol / Q000009:adverse effects / Q000031:analogs & derivatives*; D007557:Israel; D000071068:Lipocalin-2 / Q000652:urine; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020011:Protective Agents / Q000008:administration & dosage*; D011994:Recombinant Proteins / Q000008:administration & dosage; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D003287:Contrast Media; D055316:Cystatin C; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D020011:Protective Agents; D011994:Recombinant Proteins; D014283:Triiodobenzoic Acids; C103998:epoetin beta; D004921:Erythropoietin; D007472:Iohexol; C038192:iopromide; C044834:iodixanol; D000111:Acetylcysteine
keywords: acute kidney injury; angiography; chronic kidney disease; contrast media; erythropoietin