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

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2013-02, Vol.28 (2), p.337-344
• Main Authors: Tasanarong, Adis, Vohakiat, Anchalee, Hutayanon, Pisit, Piyayotai, Dilok
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - epidemiology; Acute Kidney Injury - prevention & control; Administration, Oral; Aged; alpha-Tocopherol - administration & dosage; alpha-Tocopherol - adverse effects; alpha-Tocopherol - therapeutic use; Antioxidants - administration & dosage; Antioxidants - adverse effects; Antioxidants - therapeutic use; Contrast Media - adverse effects; Coronary Angiography - adverse effects; Creatinine - blood; Double-Blind Method; Female; gamma-Tocopherol - administration & dosage; gamma-Tocopherol - adverse effects; gamma-Tocopherol - therapeutic use; Glomerular Filtration Rate - physiology; Humans; Incidence; Kidney - metabolism; Kidney - physiopathology; Male; Middle Aged; Percutaneous Coronary Intervention; Prospective Studies; Renal Insufficiency, Chronic - physiopathology
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfs525

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. 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. 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). 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.