Efficacy of Ascorbic Acid, N‐Acetylcysteine, or Combination of Both on Top of Saline Hydration versus Saline Hydration Alone on Prevention of Contrast‐Induced Nephropathy: A Prospective Randomized Study

Albabtain, Monirah A; Almasood, Ali; Alshurafah, Hytham; Alamri, Hussain; Tamim, Hani

doi:10.1111/j.1540-8183.2012.00767.x

Cited by 40 publications

(37 citation statements)

References 28 publications

(74 reference statements)

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“…In a short monitoring period, the incidence of CIN may be underestimated. Recent studies adopted longer time-periods of assessing of renal function in order to detect more cases of renal injury [28]. Our investigation is in line with this.…”

Section: Discussionsupporting

confidence: 86%

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Contrast-Induced Nephropathy in Aged Critically Ill Patients

Palli

Makris

Papanikolaou

et al. 2014

Oxidative Medicine and Cellular Longevity

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Background. Aging is associated with renal structural changes and functional decline. The attributable risk for renal dysfunction from radiocontrast agents in critically ill older patients has not been well established. Methods. In this prospective study, we assessed the incidence of contrast-induced nephropathy (CIN) in critically ill patients with stable renal function who underwent computed tomography with intravenous contrast media. Patients were categorized into two age groups: <65 (YG) or ≥65 years old (OG). CIN was defined as 25% or greater increase from baseline of serum creatinine or as an absolute increase by 0.5 mg/dL until the 5th day after the infusion of contrast agent. We also evaluated the alterations in oxidative stress by assessing serum 8-isoprostane. Results. CIN occurred in 5 of 13 OG patients (38.46%) whereas no YG patient presented CIN (P = 0.015). Serum creatinine kinetics in older patients demonstrated a rise over five days following contrast infusion time while a decline was observed in the YG (P = 0.005). Conclusions. Older critically ill patients are more prone to develop renal dysfunction after the intravenous infusion of contrast agent in relation to their younger counterparts.

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Section: Discussionsupporting

confidence: 86%

“…The exact pathophysiological mechanisms responsible for the development of CIN are complex and poorly understood [28]. Experimental studies suggest that the pathogenesis involves a combination of vasoconstrive free oxygen radicals generation, renal medullary ischemia, and direct tubular epithelial cell toxicity [32–34].…”

Section: Discussionmentioning

confidence: 99%

Contrast-Induced Nephropathy in Aged Critically Ill Patients

Palli

Makris

Papanikolaou

et al. 2014

Oxidative Medicine and Cellular Longevity

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“…Loomba et al [64] reported that the decrease in CIN following AO administration may be negligible, despite being significant, because there was a very small difference in OR and no significant difference on clinical endpoints, such as need for dialysis and mortality. A study carried out by Albabtain et al [15] showed that use of ascorbic acid, NAC, or a combination of both drugs could not be superior than the standard hydration in preventing CIN or renal function deteriorations parameters. Despite the absence of side effects, their findings did not warrant the use of antioxidants as a standard of care to prevent CIN.…”

Section: Discussionmentioning

confidence: 99%

Protective effects of anti-oxidant supplementations on contrast-induced nephropathy after coronary angiography: an updated and comprehensive meta-analysis and systematic review

et al. 2016

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A b s t r a c t Background and aim:This systematic review with meta-analysis sought to determine the strength of evidence for effects of antioxidants (AO) such as N-acetyl cysteine (NAC), vitamin C, vitamin E, and alpha-lipoic acid on the incidence of contrast-induced nephropathy (CIN), requirement for haemodialysis, level of serum creatinine, and mortality after coronary angiography. Methods and results:After Medline, Embase, Elsevier, Sciences online database, and Google Scholar literature searches, studies with randomised controlled design were selected for the meta-analysis. The effect sizes measured were odds ratio (OR) for categorical variables and standard mean difference (SMD) with 95% confidence interval (CI) for calculating differences between mean changes of serum creatinine in intervention and control groups. A value of p < 0.1 for Q test or I 2 > 50% indicated significant heterogeneity between the studies. Literature search of all major databases retrieved 2350 studies. After screening, a total of 49 trials were identified that reported outcomes. Pooled treatment effect analysis revealed that NAC (OR of 0.79; 95% CI 0.69-0.9; p = 0.000), vitamin C (0.63; 95% CI 0.45-0.89; p = 0.000), and vitamin E (OR of 0.5; 95% CI 0.27-0.92; p = 0.026) could significantly reduce the incidence of CIN. NAC (SMD of -0.119; 95% CI -0.191 --0.046; p = 0.000), but not vitamin C (SMD of -0.08; 95% CI -0.22-0.04; p = 0.1) and vitamin E (-0.25; 95% CI -0.46--0.05; p = 0.1), could significantly reduce mean levels of serum creatinine. Nevertheless, AO could not reduce the incidence of mortality, with an OR of 0.94 (95% CI 0.69-1.28; p = 0.7). Conclusions:Overall, antioxidants such as NAC, vitamin C, and vitamin E can reduce the incidence of CIN, while only NAC might be able to significantly lower serum creatinine levels. There is no impact of AO supplementation on mortality.

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“…Various drugs have been assessed as prophylactic nephroprotective agents against CI-AKI such as N-acetylcysteine (NAC) [71, 186], statins [187, 188], ascorbic acid [189–194], and theophylline [195]. But none of these have so far been approved for the prevention of CI-AKI.…”

Section: Prevention Of Ci-akimentioning

confidence: 99%

Radiographic Contrast-Media-Induced Acute Kidney Injury: Pathophysiology and Prophylactic Strategies

Sadat

2013

ISRN Radiology

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Contrast-induced acute kidney injury (CI-AKI) is one of the most widely discussed and debated topics in cardiovascular medicine. With increasing number of contrast-media- (CM-) enhanced imaging studies being performed and growing octogenarian population with significant comorbidities, incidence of CI-AKI remains high. In this review, pathophysiology of CI-AKI, its relationship with different types of CM, role of serum and urinary biomarkers for diagnosing CI-AKI, and various prophylactic strategies used for nephroprotection against CI-AKI are discussed in detail.

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Efficacy of Ascorbic Acid, N‐Acetylcysteine, or Combination of Both on Top of Saline Hydration versus Saline Hydration Alone on Prevention of Contrast‐Induced Nephropathy: A Prospective Randomized Study

Abstract: In a cohort of patients at risk of developing CIN, we could not detect any significant benefit of the use of ascorbic acid, NAC, or a combination of both drugs over the standard hydration regimen in preventing CIN.

Cited by 40 publications

References 28 publications

Contrast-Induced Nephropathy in Aged Critically Ill Patients

Contrast-Induced Nephropathy in Aged Critically Ill Patients

Protective effects of anti-oxidant supplementations on contrast-induced nephropathy after coronary angiography: an updated and comprehensive meta-analysis and systematic review

Radiographic Contrast-Media-Induced Acute Kidney Injury: Pathophysiology and Prophylactic Strategies

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