- Contrast Medium-Induced Acute Kidney Injury (CIAKI) is one of the major cause of hospital-acquired acute kidney injury.
- A decrease in antioxidant activity and direct cytotoxic effect of reactive oxygen species in have been implicated in causing CIAKI.
- Vitamin E, a fat soluble vitamin prevents CIAKI and has better outcome than Vitamin C.
Vitamin E may reduce the risk of acute kidney injury, a common adverse effect that associates with coronary angiography and percutaneous coronary interventions.
Contrast medium-induced acute kidney injury (CIAKI) is the third most frequent cause of hospital-acquired acute kidney injury due to radiological procedures.
‘Vitamin E is a fat-soluble antioxidant and it might prevent Contrast medium-induced acute kidney injury in hospitalized patients with nephropathy.’
CM is cleared entirely by the kidney, with a half-life of a few hours. It follows that the dose of CM (volume or gram of iodine) and the half-life [increased with decreased glomerular function rate (GFR)] will determine the net exposure.
CIAKI compromises about 10% of all in-hospital nephropathies and contributes to increased hospital length of stay and cost of care.
CI-AKI is commonly defined as a rise in serum creatinine (SCr) of 0.5 mg/dl or a 25% increase from the baseline value assessed at 48 h following CM administration.
A decrease in antioxidant activity and direct cytotoxic effect of reactive oxygen species in experimental models have been implicated in causing CIAKI. Previously, evidence indicated that the antioxidants N-acetylcysteine and vitamin C may prevent CIAKI. Vitamin E is a fat-soluble antioxidant and it might similarly influence the risk of CIAKI.
Yousef Rezaei from the Iran University of Medical Sciences and Harri Hemilä from the University of Helsinki in Finland analyzed the findings of three randomized trials that investigated the effects of vitamin E supplementation against CIAKI.
Two of the trials were carried out in Thailand and one was carried out in Iran. There was no heterogeneity found in the results of the three trials. The benefit of vitamin E
ranged from 52% to 75% protection against CIAKI and the pooled effect indicated a 62% prevention against CIAKI
Since the three vitamin E trials were carried out in Thailand and Iran, it is not evident whether vitamin E has similar effects in Western countries.
According to Drs. Rezaei and Hemilä, "There are no concerns about vitamin E safety in short treatments such as the administration before coronary catheterization and the vitamin is inexpensive. Therefore, the effects of vitamin E should also be investigated in Western countries to find out whether similar benefits can be observed."
- Yousef Rezaei et al., Vitamins E and C May Differ in Their Effect on Contrast-Induced Acute Kidney Injury, American Journal of Kidney Diseases (2017)