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Erschienen in: Wiener klinische Wochenschrift 9-10/2012

01.05.2012 | original article

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

verfasst von: Thomas M. Kitzler, M.D., Aala Jaberi, M.D., Gerald Sendlhofer, M.D., Peter Rehak, M.D., Christian Binder, M.D., Eva Petnehazy, M.D., Rudolf Stacher, M.D., Peter Kotanko, M.D.

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 9-10/2012

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Summary

Background

Contrast induced acute kidney injury is one of the most frequent causes of hospital acquired acute kidney injury. The present study aims to investigate the efficacy of vitamin E or N-acetylcysteine as an adjunct to current standard therapy in the prevention of this clinical predicament. We tested the hypothesis that vitamin E or N-acetylcysteine added to standard therapy with 0.45 % saline is superior in preserving renal function in patients with chronic kidney disease stage 1–4 undergoing elective computer-assisted tomography with nonionic radiocontrast agents when compared to 0.45 % saline alone.

Design

Prospective, randomized, single-center, double-masked, double dummy, placebo-controlled, parallel clinical trial.

Methods

The patients were randomized to either vitamin E (total dose 2160 mg i.v.) or N-acetylcysteine (total dose 4800 mg p.o.) in addition to 0.45 % saline (1 mL/kg/h over 24 h) or saline alone. Serum creatinine change between baseline and 24 h after radiocontrast was the primary outcome. Contrast induced acute kidney injury was defined as a rise in serum creatinine > 25 % over the baseline value within 48 h.

Results

Thirty patients (mean age 74.6 years; 17 females; 9 diabetics; all Caucasians; mean serum creatinine 1.35 mg/dL; mean creatinine clearance 56 mL/min) were enrolled. No patient developed contrast induced acute kidney injury. There was no significant difference in serum creatinine change between the three study arms.

Conclusion

Following radiocontrast administration, neither vitamin E nor N-acetylcystein in addition to saline demonstrated an additional beneficial effect on kidney function when compared to saline alone.
Literatur
1.
Zurück zum Zitat McCullough PA, Sandberg KR. Epidemiology of contrast-induced nephropathy. Rev Cardiovasc Med. 2003;4 (Suppl 5):S3–9. McCullough PA, Sandberg KR. Epidemiology of contrast-induced nephropathy. Rev Cardiovasc Med. 2003;4 (Suppl 5):S3–9.
2.
Zurück zum Zitat Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006;100:S11–5.PubMedCrossRef Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006;100:S11–5.PubMedCrossRef
3.
4.
Zurück zum Zitat From AM, Bartholmai BJ, Williams AW, Cha SS, Pflueger A, McDonald FS. Sodium bicarbonate is associated with an increased incidence of contrast nephropathy: a retrospective cohort study of 7977 patients at mayo clinic. Clin J Am Soc Nephrol. 2008;3:10–18.PubMedCrossRef From AM, Bartholmai BJ, Williams AW, Cha SS, Pflueger A, McDonald FS. Sodium bicarbonate is associated with an increased incidence of contrast nephropathy: a retrospective cohort study of 7977 patients at mayo clinic. Clin J Am Soc Nephrol. 2008;3:10–18.PubMedCrossRef
5.
Zurück zum Zitat Persson PB, Hansell P, Liss P. Pathophysiology of contrast medium-induced nephropathy. Kidney Int. 2005;68:14–22.PubMedCrossRef Persson PB, Hansell P, Liss P. Pathophysiology of contrast medium-induced nephropathy. Kidney Int. 2005;68:14–22.PubMedCrossRef
6.
7.
Zurück zum Zitat Brezis M, Rosen S. Hypoxia of the renal medulla–its implications for disease. N Engl J Med. 1995;332:647–55.PubMedCrossRef Brezis M, Rosen S. Hypoxia of the renal medulla–its implications for disease. N Engl J Med. 1995;332:647–55.PubMedCrossRef
8.
Zurück zum Zitat Arakawa K, Suzuki H, Naitoh M, Matsumoto A, Hayashi K, Matsuda H, et al. Role of adenosine in the renal responses to contrast medium. Kidney Int. 1996;49:1199–1206.PubMedCrossRef Arakawa K, Suzuki H, Naitoh M, Matsumoto A, Hayashi K, Matsuda H, et al. Role of adenosine in the renal responses to contrast medium. Kidney Int. 1996;49:1199–1206.PubMedCrossRef
9.
Zurück zum Zitat Workman RJ, Shaff MI, Jackson RV, Diggs J, Frazer MG, Briscoe C. Relationship of renal hemodynamic and functional changes following intravascular contrast to the renin-angiotensin system and renal prostacyclin in the dog. Invest Radiol. 1983;18:160–6.PubMedCrossRef Workman RJ, Shaff MI, Jackson RV, Diggs J, Frazer MG, Briscoe C. Relationship of renal hemodynamic and functional changes following intravascular contrast to the renin-angiotensin system and renal prostacyclin in the dog. Invest Radiol. 1983;18:160–6.PubMedCrossRef
10.
Zurück zum Zitat Liss P, Nygren A, Olsson U, Ulfendahl HR, Erikson U. Effects of contrast media and mannitol on renal medullary blood flow and red cell aggregation in the rat kidney. Kidney Int. 1996;49:1268–75.PubMedCrossRef Liss P, Nygren A, Olsson U, Ulfendahl HR, Erikson U. Effects of contrast media and mannitol on renal medullary blood flow and red cell aggregation in the rat kidney. Kidney Int. 1996;49:1268–75.PubMedCrossRef
11.
Zurück zum Zitat Nygren A, Ulfendahl HR, Hansell P, Erikson U. Effects of intravenous contrast media on cortical and medullary blood flow in the rat kidney. Invest Radiol. 1988;23:753–61.PubMedCrossRef Nygren A, Ulfendahl HR, Hansell P, Erikson U. Effects of intravenous contrast media on cortical and medullary blood flow in the rat kidney. Invest Radiol. 1988;23:753–61.PubMedCrossRef
12.
Zurück zum Zitat Bakris GL, Lass NA, Glock D. Renal hemodynamics in radiocontrast medium-induced renal dysfunction: a role for dopamine-1 receptors. Kidney Int. 1999;56:206–10.PubMedCrossRef Bakris GL, Lass NA, Glock D. Renal hemodynamics in radiocontrast medium-induced renal dysfunction: a role for dopamine-1 receptors. Kidney Int. 1999;56:206–10.PubMedCrossRef
13.
Zurück zum Zitat Stone GW, McCullough PA, Tumlin JA, Lepor NE, Madyoon H, Murray P, et al. Fenoldopam mesylate for the prevention of contrast-induced nephropathy: a randomized controlled trial. JAMA. 2003;290:2284–91.PubMedCrossRef Stone GW, McCullough PA, Tumlin JA, Lepor NE, Madyoon H, Murray P, et al. Fenoldopam mesylate for the prevention of contrast-induced nephropathy: a randomized controlled trial. JAMA. 2003;290:2284–91.PubMedCrossRef
14.
Zurück zum Zitat Juncos R, Garvin JL. Superoxide enhances Na-K-2Cl cotransporter activity in the thick ascending limb. Am J Physiol Renal Physiol. 2005;288:F982–7.PubMedCrossRef Juncos R, Garvin JL. Superoxide enhances Na-K-2Cl cotransporter activity in the thick ascending limb. Am J Physiol Renal Physiol. 2005;288:F982–7.PubMedCrossRef
15.
Zurück zum Zitat Wellman TL, Jenkins J, Penar PL, Tranmer B, Zahr R, Lounsbury KM. Nitric oxide and reactive oxygen species exert opposing effects on the stability of hypoxia-inducible factor-1alpha (HIF-1alpha) in explants of human pial arteries. FASEB J. 2004;18:379–81.PubMed Wellman TL, Jenkins J, Penar PL, Tranmer B, Zahr R, Lounsbury KM. Nitric oxide and reactive oxygen species exert opposing effects on the stability of hypoxia-inducible factor-1alpha (HIF-1alpha) in explants of human pial arteries. FASEB J. 2004;18:379–81.PubMed
16.
Zurück zum Zitat Drager LF, Andrade L, Barros de Toledo JF, Laurindo FR, Machado Cesar LA, Seguro AC. Renal effects of N-acetylcysteine in patients at risk for contrast nephropathy: decrease in oxidant stress-mediated renal tubular injury. Nephrol Dial Transplant. 2004;19:1803–7.PubMedCrossRef Drager LF, Andrade L, Barros de Toledo JF, Laurindo FR, Machado Cesar LA, Seguro AC. Renal effects of N-acetylcysteine in patients at risk for contrast nephropathy: decrease in oxidant stress-mediated renal tubular injury. Nephrol Dial Transplant. 2004;19:1803–7.PubMedCrossRef
17.
Zurück zum Zitat Sandhu C, Newman DJ, Morgan R, Belli AM, Oliveira D. The role of oxygen free radicals in contrast induced nephrotoxicity. Acad Radiol. 2002;9 (Suppl 2):S436–7.PubMedCrossRef Sandhu C, Newman DJ, Morgan R, Belli AM, Oliveira D. The role of oxygen free radicals in contrast induced nephrotoxicity. Acad Radiol. 2002;9 (Suppl 2):S436–7.PubMedCrossRef
18.
Zurück zum Zitat Palm F, Cederberg J, Hansell P, Liss P, Carlsson PO. Reactive oxygen species cause diabetes-induced decrease in renal oxygen tension. Diabetologia. 2003;46:1153–60.PubMedCrossRef Palm F, Cederberg J, Hansell P, Liss P, Carlsson PO. Reactive oxygen species cause diabetes-induced decrease in renal oxygen tension. Diabetologia. 2003;46:1153–60.PubMedCrossRef
19.
Zurück zum Zitat Abd-El-Fattah AA, El-Sawalhi MM, Rashed ER, El-Ghazaly MA. Possible role of vitamin E, coenzyme Q10 and rutin in protection against cerebral ischemia/reperfusion injury in irradiated rats. Int J Radiat Biol. 2010;86:1070–8.PubMedCrossRef Abd-El-Fattah AA, El-Sawalhi MM, Rashed ER, El-Ghazaly MA. Possible role of vitamin E, coenzyme Q10 and rutin in protection against cerebral ischemia/reperfusion injury in irradiated rats. Int J Radiat Biol. 2010;86:1070–8.PubMedCrossRef
20.
Zurück zum Zitat Abu-Amara M, Gurusamy K, Hori S, Glantzounis G, Fuller B, Davidson BR. Systematic review of randomized controlled trials of pharmacological interventions to reduce ischaemia-reperfusion injury in elective liver resection with vascular occlusion. HPB (Oxford). 2010;12:4–14.CrossRef Abu-Amara M, Gurusamy K, Hori S, Glantzounis G, Fuller B, Davidson BR. Systematic review of randomized controlled trials of pharmacological interventions to reduce ischaemia-reperfusion injury in elective liver resection with vascular occlusion. HPB (Oxford). 2010;12:4–14.CrossRef
21.
Zurück zum Zitat Pflueger A, Abramowitz D, Calvin AD. Role of oxidative stress in contrast-induced acute kidney injury in diabetes mellitus. Med Sci Monit. 2009;15:RA125–36.PubMed Pflueger A, Abramowitz D, Calvin AD. Role of oxidative stress in contrast-induced acute kidney injury in diabetes mellitus. Med Sci Monit. 2009;15:RA125–36.PubMed
22.
Zurück zum Zitat Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461–70.PubMed Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461–70.PubMed
23.
Zurück zum Zitat Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.PubMed Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.PubMed
24.
Zurück zum Zitat Tepel M, Van Der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med. 2000;343:180–4.PubMedCrossRef Tepel M, Van Der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med. 2000;343:180–4.PubMedCrossRef
25.
Zurück zum Zitat Amini M, Salarifar M, Amirbaigloo A, Masoudkabir F, Esfahani F. N-acetylcysteine does not prevent contrast-induced nephropathy after cardiac catheterization in patients with diabetes mellitus and chronic kidney disease: a randomized clinical trial. Trials. 2009;10:45.PubMedCrossRef Amini M, Salarifar M, Amirbaigloo A, Masoudkabir F, Esfahani F. N-acetylcysteine does not prevent contrast-induced nephropathy after cardiac catheterization in patients with diabetes mellitus and chronic kidney disease: a randomized clinical trial. Trials. 2009;10:45.PubMedCrossRef
26.
Zurück zum Zitat Calvin AD, Misra S, Pflueger A. Contrast-induced acute kidney injury and diabetic nephropathy. Nat Rev Nephrol. 2010;6:679–88.PubMedCrossRef Calvin AD, Misra S, Pflueger A. Contrast-induced acute kidney injury and diabetic nephropathy. Nat Rev Nephrol. 2010;6:679–88.PubMedCrossRef
27.
Zurück zum Zitat Marenzi G, Assanelli E, Marana I, Lauri G, Campodonico J, Grazi M, et al. N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med. 2006;354:2773–82.PubMedCrossRef Marenzi G, Assanelli E, Marana I, Lauri G, Campodonico J, Grazi M, et al. N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med. 2006;354:2773–82.PubMedCrossRef
28.
Zurück zum Zitat Rigotti A. Absorption, transport, and tissue delivery of vitamin E. Mol Aspects Med. 2007;28:423–36.PubMedCrossRef Rigotti A. Absorption, transport, and tissue delivery of vitamin E. Mol Aspects Med. 2007;28:423–36.PubMedCrossRef
29.
Zurück zum Zitat Nakamura T, Aoyama Y, Fujita T, Katsui G. Studies on tocopherol derivatives: V. Intestinal absorption of several d,1–3,4–3H2-alpha-tocopheryl esters in the rat. Lipids. 1975;10:627–33.PubMedCrossRef Nakamura T, Aoyama Y, Fujita T, Katsui G. Studies on tocopherol derivatives: V. Intestinal absorption of several d,1–3,4–3H2-alpha-tocopheryl esters in the rat. Lipids. 1975;10:627–33.PubMedCrossRef
30.
Zurück zum Zitat Traber MG, Goldberg I, Davidson E, Lagmay N, Kayden HJ. Vitamin E uptake by human intestinal cells during lipolysis in vitro. Gastroenterology. 1990;98:96–103.PubMed Traber MG, Goldberg I, Davidson E, Lagmay N, Kayden HJ. Vitamin E uptake by human intestinal cells during lipolysis in vitro. Gastroenterology. 1990;98:96–103.PubMed
31.
Zurück zum Zitat Tasanarong A, Piyayotai D, Thitiarchakul S. Protection of radiocontrast induced nephropathy by vitamin E (alpha tocopherol): a randomized controlled pilot study. J Med Assoc Thai. 2009;92:1273–81.PubMed Tasanarong A, Piyayotai D, Thitiarchakul S. Protection of radiocontrast induced nephropathy by vitamin E (alpha tocopherol): a randomized controlled pilot study. J Med Assoc Thai. 2009;92:1273–81.PubMed
32.
Zurück zum Zitat Briguori C, Airoldi F, D’Andrea D, Bonizzoni E, Morici N, Focaccio A, et al. Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL): a randomized comparison of 3 preventive strategies. Circulation. 2007;115:1211–7.PubMed Briguori C, Airoldi F, D’Andrea D, Bonizzoni E, Morici N, Focaccio A, et al. Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL): a randomized comparison of 3 preventive strategies. Circulation. 2007;115:1211–7.PubMed
Metadaten
Titel
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
verfasst von
Thomas M. Kitzler, M.D.
Aala Jaberi, M.D.
Gerald Sendlhofer, M.D.
Peter Rehak, M.D.
Christian Binder, M.D.
Eva Petnehazy, M.D.
Rudolf Stacher, M.D.
Peter Kotanko, M.D.
Publikationsdatum
01.05.2012
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 9-10/2012
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-012-0169-2

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