The Effect of Administration of Ascorbic Acid in Prevention of Contrast Induced Nephropathy in Patients With Renal Impairment Undergoing Coronary Intervention

Abstract

Background: Contrast-induced nephropathy is a potentially avoidable complication caused during procedures involving the use of radiographic contrast media. All subjects, especially the high-risk ones, should be subjected to available preventive protocols prior to and after such procedures. Objective:To evaluate the role of a hydration protocol involving the use of ascorbic acid plus the conventional sodium chloride hydration protocol N acetyl cysteine. Patients and methods:The current study was conducted on 86 patients presenting to the Cardiology Department at National Heart Institute to undergo elective percutaneous coronary intervention (PCI) during the period from April 2011 to November 2011. The study population was divided into two equal groups: Group 1 received ascorbic acid prior and after the procedure and group 2 received the conventional hydration measures without ascorbic acid. Both groups received normal saline and NAC (N Acetyl Cysteine).Results: There were no significant group differences regarding sex, incidence of diabetes mellitus, preexisting renal impairment, age, hypertension, dyslipidemia, and the type and amount of contrast. Addition of ascorbic acid by hydration with normal saline and N-acetyle cysteine decreased significantly the rise in serum creatinine 48 hours (P=0.023) and 7 days (P=0.001) following coronary intervention. CIN occurred in one patient in ascorbic acid group versus 4 patients in the control group (P=0.36). Ascorbic acid did not show a significant effect regarding the protection against the contrast induced nephropathy versus the conventional hydration therapy. Conclusion:Ascorbic acid did not show a significant effect regarding the protection against the contrast induced nephropathy versus the conventional hydration therapy.

Endogenous and Exogenous Antioxidants as Agents Preventing the Negative Effects of Contrast Media (Contrast-Induced Nephropathy)

“…NAC positive on humans [53][54][55][56][57][58]60], meta-analyses [59,61,71] no results on humans [62][63][64][65][66][67], meta-analyses [68,69,72] Glutathione no results on humans [78][79][80] Vitamin C positive on humans [96][97][98], meta-analyses [94,95] no results on humans [99][100][101][102][103][104] Vitamin E positive on humans, meta-analyses [113,114] no results on humans [115,116] Bilirubin/HO-1 positive (expected)…”

“…However, there are some conflicting data on the effectiveness of ascorbic acid in reducing the development of CIN. A number of studies have shown the absence of a nephroprotective effect of ascorbic acid upon administration of contrast agents [ 99 , 100 , 101 , 102 , 103 ]. No effects of ascorbic acid and NAC on CIN in critical care patients were found in [ 104 ].…”