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Nephrol Dial Transplant. 2013 Feb;28(2):337-44. doi: 10.1093/ndt/gfs525. Epub 2013 Jan 12.

New strategy of α- and γ-tocopherol to prevent contrast-induced acute kidney injury in chronic kidney disease patients undergoing elective coronary procedures.

Author information

  • 1Nephrology Unit, Department of Medicine, Faculty of Medicine, Thammasat University (Rangsit Campus), Klong Luang, Pathumtani 12121, Thailand. adis_tasanarong@hotmail.com

Abstract

BACKGROUND:

Contrast-induced acute kidney injury (CI- AKI) increases the likelihood of patient morbidity and mortality following coronary procedures. Volume supplement with saline is the standard treatment to prevent CI-AKI. Additional antioxidant prophylaxis has often yielded conflicting results. The present study was conducted to examine the role of novel application vitamin E (tocopherol) in preventing CI-AKI.

METHODS:

This prospective, double-blind, randomized and placebo-controlled trial was carried out in 305 patients with chronic kidney disease (CKD) undergoing coronary procedures. All patients were randomly assigned to prophylaxis administration with 0.9% saline infusions plus daily oral medication comprised of either (i) placebo (n = 101), (ii) α-tocopherol (n = 102) or (iii) γ-tocopherol (n = 102) starting 5 days before and ending 2 days after coronary procedures. The CI-AKI risk score of each patient was calculated. All coronary procedures were performed using a low-osmolar, non-ionic contrast agent.

RESULTS:

CI-AKI developed in 14.9% in the placebo group, 4.9% in the α-tocopherol group (P = 0.02 versus the placebo group) and 5.9% in the γ-tocopherol group (P = 0.04 versus the placebo group). In patients with diabetes, hypertension, anaemia, aged over 55 years, male gender or with contrast agent dosages >120 mL, α-tocopherol showed a larger effect than γ-tocopherol when compared with the placebo group (P < 0.05).

CONCLUSIONS:

Prophylaxis administration with oral α- or γ-tocopherol in combination with 0.9% saline is effective in protecting against CI-AKI in CKD patients undergoing elective coronary procedures.

PMID:
23314316
[PubMed - indexed for MEDLINE]
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