Comparing the Effect of Vitamin E and N-Acetylcysteine on Prevention of Contrast-Induced Nephropathy in Diabetic Patients under Coronary Angiography
Men's Health Journal,
Vol. 5 No. 1 (2021),
6 January 2021
,
Page e4
https://doi.org/10.22037/mhj.v5i1.33724
Abstract
Introduction: Considering the incidence of contrast induced nephropathy (CIN) as well as its complications and costs, prevention and reducing the risk of CIN is an essential issue. The present study aimed to evaluate the efficacy of vitamin E and N-acetylcysteine (NAC) on the prevention of CIN in diabetic patients undergoing coronary angiography.
Materials and Methods: 360 patients with diabetes who required angiography, including patients with stable angina susceptible to acute myocardial infarction and patients with acute coronary syndrome were included and randomized into three groups . Group 1 received serum therapy (Normal Saline) plus NAC and placebo of vitamin E, group 2 received serum therapy plus vitamin E and placebo of NAC, and group 3 only received serum therapy with two placebos of NAC and vitamin E. The groups were compared considering CIN after angiography. Results: A total of 93 patients were studied in group 1, 94 in group 2, and 113 in group 3. CIN occurred in 4 patients (4.3%), 4 patients (4.3%), and 8 patients (7.1%) in groups 1, 2, and 3, respectively (P=0.58). There was a significant difference in mean difference of creatinine levels before and after study in groups 1 and 2 (both P<0.001). In the subgroup of patients with chronic kidney disease, NAC significantly reduced CIN (P=0.03).
Conclusion: The results suggested efficacy of both interventions, considering reduction of mean Serum creatinine ( Scr) after the study, while lack of significant difference in the incidence of CIN could be because of the low number of CIN in our study. The second important finding of this study, probably the reduced risk of CIN in diabetic patients with chronic kidney disease receiving NAC, recommends the use of NAC for prevention of CIN, especially in this subgroup of patients undergoing angiography.
- Acetylcysteine
- Angiography
- Diabetes Mellitus
- Kidney Diseases
- Vitamin E
How to Cite
References
2. Aubry P, Brillet G, Catella L, Schmidt A, Bénard S. Outcomes, risk factors and health burden of contrast-induced acute kidney injury: an observational study of one million hospitalizations with image-guided cardiovascular procedures. BMC nephrology. 2016;17(1):167.
3. Seeliger E, Sendeski M, Rihal CS, Persson PB. Contrast-induced kidney injury: mechanisms, risk factors, and prevention. European heart journal. 2012;33(16):2007-15.
4. Sudarsky D, Nikolsky E. Contrast-induced nephropathy in interventional cardiology. International journal of nephrology and renovascular disease. 2011;4:85.
5. Evola S, Lunetta M, Macaione F, Fonte G, Milana G, Corrado E, et al. Risk factors for contrast induced nephropathy: A study among Italian patients. Indian heart journal. 2012;64(5):484-91.
6. Heyman SN, Rosenberger C, Rosen S, Khamaisi M. Why is diabetes mellitus a risk factor for contrast-induced nephropathy? BioMed Research International. 2013;2013.
7. Maliborski A, Żukowski P, Nowicki G, Bogusławska R. Contrast-induced nephropathy–a review of current literature and guidelines. Medical science monitor: international medical journal of experimental and clinical research. 2011;17(9):RA199.
8. Faggioni M, Mehran R. Preventing contrast-induced renal failure: a guide. Interventional Cardiology Review. 2016;11(2):98.
9. Ali-Hasan-Al-Saegh S, Mirhosseini SJ, Ghodratipour Z, Sarafan-Chaharsoughi Z, Dehghan AM, Rahimizadeh E, et al. Protective effects of anti-oxidant supplementations on contrast-induced nephropathy after coronary angiography: an updated and comprehensive meta-analysis and systematic review. Kardiologia Polska (Polish Heart Journal). 2016;74(7):610-26.
10. Tasanarong A, Vohakiat A, Hutayanon P, Piyayotai D. New strategy of α-and γ-tocopherol to prevent contrast-induced acute kidney injury in chronic kidney disease patients undergoing elective coronary procedures. Nephrology Dialysis Transplantation. 2013;28(2):337-44.
11. Cho MH, Kim SN, Park HW, Chung S, Kim KS. Could vitamin E prevent contrast-induced acute kidney injury? A systematic review and meta-analysis. Journal of Korean medical science. 2017;32(9):1468-73.
12. Su X, Xie X, Liu L, Lv J, Song F, Perkovic V, et al. Comparative effectiveness of 12 treatment strategies for preventing contrast-induced acute kidney injury: a systematic review and Bayesian network meta-analysis. American Journal of Kidney Diseases. 2017;69(1):69-77.
13. Ali-Hassan-Sayegh S, Mirhosseini SJ, Ghodratipour Z, Sarrafan-Chaharsoughi Z, Rahimizadeh E, Karimi-Bondarabadi AA, et al. Strategies preventing contrast-induced nephropathy after coronary angiography: a comprehensive meta-analysis and systematic review of 125 randomized controlled trials. Angiology. 2017;68(5):389-413.
14. Sun Z, Fu Q, Cao L, Jin W, Cheng L, Li Z. Intravenous N-acetylcysteine for prevention of contrast-induced nephropathy: a meta-analysis of randomized, controlled trials. PloS one. 2013;8(1):e55124.
15. Xu R, Tao A, Bai Y, Deng Y, Chen G. Effectiveness of N‐Acetylcysteine for the Prevention of Contrast‐Induced Nephropathy: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials. Journal of the American Heart Association. 2016;5(9):e003968.
16. Nough H, Eghbal F, Soltani M, Nejafi F, Falahzadeh H, Fazel H, et al. Incidence and main determinants of contrast-induced nephropathy following coronary angiography or subsequent balloon angioplasty. Cardiorenal medicine. 2013;3(2):128-35.
17. Mirzaei M, Rahmaninan M, Mirzaei M, Nadjarzadeh A. Epidemiology of diabetes mellitus, pre-diabetes, undiagnosed and uncontrolled diabetes in Central Iran: results from Yazd health study. BMC Public Health. 2020;20(1):166.
18. Calvin AD, Misra S, Pflueger A. Contrast-induced acute kidney injury and diabetic nephropathy. Nature Reviews Nephrology. 2010;6(11):679-88.
19. Golshahi J, Nasri H, Gharipour M. Contrast-induced nephropathy; A literature review. Journal of nephropathology. 2014;3(2):51.
20. Rahman M, Haque H, Banerjee S, Ahsan S, Rahman M, Mahmood M, et al. Contrast induced nephropathy in diabetic and non-diabetic patients during coronary angiogram and angioplasty. Mymensingh medical journal: MMJ. 2010;19(3):372-6.
21. Xue-chao W, Xiang-hua F, Yan-bo W, Xin-wei J, Wei-li W, Xin-shun G, et al. Prediction of contrast-induced nephropathy in diabetics undergoing elective percutaneous coronary intervention: role of the ratio of contrast medium volume to estimated glomerular filtration rate. Chinese medical journal. 2011;124(6):892-6.
22. Worasuwannarak S, Pornratanarangsi S. Prediction of contrast-induced nephropathy in diabetic patients undergoing elective cardiac catheterization or PCI: role of volume-to-creatinine clearance ratio and iodine dose-to-creatinine clearance ratio. J Med Assoc Thai. 2010;93(Suppl 1):S29-S34.
23. Schilp J, de Blok C, Langelaan M, Spreeuwenberg P, Wagner C. Guideline adherence for identification and hydration of high-risk hospital patients for contrast-induced nephropathy. BMC nephrology. 2014;15(1):2.
24. Burchardt P, Guzik P, Tabaczewski P, Synowiec T, Bogdan M, Faner P, et al. Early renal dysfunction after contrast media administration despite prophylactic hydration. The international journal of cardiovascular imaging. 2013;29(5):959-66.
25. Sar F, Saler T, Ecebay A, Saglam ZA, Ozturk S, Kazancioglu R. The efficacy of n-acetylcysteine in preventing contrast-induced nephropathy in type 2 diabetic patients without nephropathy. JN journal of nephrology. 2010;23(4):478.
26. Berwanger O, Cavalcanti AB, Sousa AM, Buehler A, Castello-Júnior HJ, Cantarelli MJ, et al. Acetylcysteine for the prevention of renal outcomes in patients with diabetes mellitus undergoing coronary and peripheral vascular angiography: a substudy of the acetylcysteine for contrast-induced nephropathy trial. Circulation: Cardiovascular Interventions. 2013;6(2):139-45.
27. Carbonell N, Sanjuán R, Blasco M, Jordá Á, Miguel A. N-acetylcysteine: short-term clinical benefits after coronary angiography in high-risk renal patients. Revista Española de Cardiología (English Edition). 2010;63(1):12-9.
28. Khaledifar A, Momeni A, Ebrahimi A, Kheiri S, Mokhtari A. Comparison of N-acetylcysteine, ascorbic acid, and normal saline effect in prevention of contrast-induced nephropathy. ARYA atherosclerosis. 2015;11(4):228.
29. Boedeker R-H, Scheibelhut C, Boening A. Usefulness of N-acetylcysteine or ascorbic acid versus placebo to prevent contrast-induced acute kidney injury in patients undergoing elective cardiac catheterization: a single-center, prospective, randomized, double-blind, placebo-controlled trial. J Invasive Cardiol. 2013;25(6):276-83.
30. Hoste EA, Doom S, De Waele J, Delrue LJ, Defreyne L, Benoit DD, et al. Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis. Intensive care medicine. 2011;37(12):1921-31.
31. Kitzler TM, Jaberi A, Sendlhofer G, Rehak P, Binder C, Petnehazy E, et al. 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. Wiener klinische Wochenschrift. 2012;124(9-10):312-9.
32. Rezaei Y, Khademvatani K, Rahimi B, Khoshfetrat M, Arjmand N, Seyyed‐Mohammadzad MH. 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. Journal of the American Heart Association. 2016;5(3):e002919.
33. Monami M, Cignarelli A, Pinto S, D’Onofrio L, Milluzzo A, Miccoli R, et al. Alpha-Tocopherol and contrast-induced nephropathy: A meta-analysis of randomized controlled trials. International Journal for Vitamin and Nutrition Research. 2019.
- Abstract Viewed: 183 times
- pdf Downloaded: 157 times