Randomized trial to assess the potential role of ascorbic acid and statin for post-contrast acute kidney injury prevention

• Published in: International urology and nephrology 2024-02, Vol.56 (2), p.399-405
• Main Authors: Hashem, Abdelwahab, Laymon, Mahmoud, Elgamal, Mostafa, Hegazy, Mohammed, Elmeniar, A. M., Refaie, Huda, Osman, Yasser
• Format: Article
• Language: English
• Subjects: Acids; Acute Kidney Injury - chemically induced; Acute Kidney Injury - epidemiology; Acute Kidney Injury - prevention & control; Ascorbic acid; Ascorbic Acid - therapeutic use; Atorvastatin; Atorvastatin - adverse effects; Computed tomography; Contrast Media - adverse effects; Creatinine; Epidermal growth factor receptors; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Kidneys; Medicine; Medicine & Public Health; Nephrology; Placebos; Statins; Urology; Urology - Original Paper
• ISSN: 1573-2584; 0301-1623; 1573-2584
• DOI: 10.1007/s11255-023-03806-8

Purpose To evaluate the effect of using statins and ascorbic acid for the prevention of post-contrast acute kidney injury (PC-AKI) in patients undergoing urologic diagnostic elective contrast-enhanced computed tomography (CECT). Methods This registered trial (NCT03391830) was for statin naïve patients underwent elective CECT. Patients were randomized allocated to two groups: the first group received atorvastatin 80-mg the day before the study and atorvastatin 40-mg two hours before the CECT and for continue on atorvastatin 40-mg two days after CECT; plus ascorbic acid 500 mg with atorvastatin. The other group received two tablets of placebo once/daily before the procedure and for another 3 days. The primary outcome was to assess the incidence PC-AKI. Results The baseline parameters were comparable between both groups. The final median (interquartile range “IQR”) serum creatinine were 0.80 (0.60, 1.00) and 0.80 (0.60, 1.00), respectively, with insignificant p -value ( p  = 0.8). The median (IQR) final estimated GFR were 95.2 (72.8, 108.1) and 88.6 (71.9, 111.0) mL/min in placebo and statin plus ascorbic acid groups, respectively ( p  = 0.48). The eGFR difference median (IQR) were − 6.46 (− 11.72, − 4.18) and − 6.57 (− 13.38, − 3.82) ml/min in placebo and statin plus ascorbic acid groups, respectively ( p  = 0.58). PC-AKI occurred in 11 patients (9.8%) in placebo group and in 3 patients (3%) in statin plus ascorbic acid group ( p  = 0.04). Conclusions Statin and ascorbic acid did not statistically improve neither serum creatinine nor eGFR values in patient underwent CECT. However, it can decrease the incidence of the clinically insignificant PC-AKI.