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

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. methods and 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 m2-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]×103/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. © 2016 the authors.