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.
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.
  
  
  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.
  
  
  BACKGROUND
  URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02070679.
authors.affiliation: Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran yousefrezaei1986@gmail.com hmohammadzad@gmail.com.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Rezaei
authors.affiliation: Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran.
authors.forename: Kamal
authors.initials: K
authors.lastname: Khademvatani
authors.affiliation: Department of Cardiology, Taleghani Hospital, Urmia University of Medical Sciences, Urmia, Iran.
authors.forename: Behzad
authors.initials: B
authors.lastname: Rahimi
authors.affiliation: Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran.
authors.forename: Mehran
authors.initials: M
authors.lastname: Khoshfetrat
authors.affiliation: Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran.
authors.forename: Nasim
authors.initials: N
authors.lastname: Arjmand
authors.affiliation: Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran yousefrezaei1986@gmail.com hmohammadzad@gmail.com.
authors.forename: Mir-Hossein
authors.initials: MH
authors.lastname: Seyyed-Mohammadzad
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D000368:Aged; D000975:Antioxidants / Q000008:administration & dosage* / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D005919:Glomerular Filtration Rate; D006801:Humans; D007263:Infusions, Parenteral; D057194:Intention to Treat Analysis; D007492:Iran; D007668:Kidney / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012307:Risk Factors; D012965:Sodium Chloride / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids / Q000008:administration & dosage / Q000009:adverse effects*; D014815:Vitamins / Q000008:administration & dosage* / Q000009:adverse effects; D024502:alpha-Tocopherol / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000975:Antioxidants; D015415:Biomarkers; D003287:Contrast Media; D014283:Triiodobenzoic Acids; D014815:Vitamins; D012965:Sodium Chloride; D003404:Creatinine; D024502:alpha-Tocopherol; C044834:iodixanol
keywords: chronic kidney disease; contrast‐induced acute kidney injury; coronary angiography; vitamin E