Use of Alpha-Lipoic Acid in Prevention of Contrast-Induced Nephropathy in Diabetic Patients

Abstract

In this prospective study, we aimed to determine the protective antioxidant role of alpha-lipoic acid (ALA) on development of contrast-induced nephropathy (CIN) in diabetic patients undergoing coronary angiography. Seventy-eight diabetic patients undergoing coronary angiography were included. Thirty-nine patients were randomized to control group and 39 patients to ALA group. Both groups were hydrated on the day of angiography, and the ALA group had also received three doses of "Thioctacid 600 mg HR, MEDA Manufacturing GmbH" in pill form. Serum creatinine clearance, cystatin C, and urinary neutrophil gelatinase-associated lipocalin (NGAL) were studied before and after angiography. We defined CIN as either !25% or !0.5 mg/dL increase in serum creatinine at 48th hour after angiography. Baseline clinical characteristics were similar in both groups. Mehran risk score and creatinine clearance were comparable in control and therapy groups (5.59 AE 1.96 vs. 5.49 AE 1.73, p ¼ 0.54 and 89 AE 21 vs. 96 AE 24, p ¼ 0.13, respectively). The volumes of contrast media (median values of 80 mL vs. 75 mL) and hydration with saline (2862 AE 447 mL vs. 2637 AE 592 mL) were also similar (p > 0.05). The incidence of CIN was the same (8%) in both the groups. Alterations in serum creatinine, cystatin C, and urinary NGAL levels before and after the procedure were comparable between the ALA and control groups (group pvalues were >0.05 in two-way repeated measures analysis of variance). We presented for the first time that ALA therapy added to hydration does not decrease the risk of CIN development in diabetic patients undergoing coronary angiography.

Comparison of Carvedilol and Metoprolol for Preventing Contrast-Induced Nephropathy after Coronary Angiography

“…Its structure is not affected by inflammation, dietary factors, sex, age or muscle mass [11,12,13]. Several studies examined the role of cystatin C in predicting CIN [14,15,16,17,18]. Ebru et al [14] showed that only cystatin C increase after contrast media exposure is in concordance with the Mehran risk scoring system for predicting the risk of CIN.…”

“…The best predictive capabilities were provided by the cystatin C/creatinine ratio. In a recent study by Cicek et al [17], serum cystatin C levels were found to be elevated in diabetic patients who developed CIN compared to those who did not. In contrast, Ribichini at al.…”

Essential role of Nrf2 in the protective effect of lipoic acid against lipoapoptosis in hepatocytes

“…On the other hand, LA exerts beneficial physiological effects such as attenuation of oxidative stress, prevention of body weight gain induced by HFD and reduction of energy efficiency [33][34][35]. Moreover, some clinical trials demonstrate the ability of LA supplementation to improve T2DM and different complications such as retinopathy [36,37] or nephropathy [38,39]. In animal models, some beneficial effects of LA supplementation in reducing markers of oxidative and ER stress in NAFLD have been reported [40,41].…”

Contrast-Induced Nephropathy: Management by Antioxidant Therapy

“…ALA'nın KMN gelişimi üzerine koruyucu etkisi gösterilememiştir. Bir başka çalışmada PKG yapılan 78 diyabetik hastaya ALA uygulanmış ve koruyucu etkisi göste-rilememiştir (13) .…”