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Prevention of contrast-induced nephropathy with ascorbic acid
1Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, China.
Insights
High-dose ascorbic acid did not prevent contrast-induced nephropathy in patients with renal insufficiency undergoing coronary angiography. This study found no significant difference in renal function changes between ascorbic acid and control groups.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Antioxidant ascorbic acid (vitamin C) has shown potential renal protective effects.
- Evidence for its efficacy in preventing contrast-induced nephropathy (CIN) is limited.
- High-risk patients with renal insufficiency undergoing coronary angiography are particularly vulnerable to CIN.
Purpose of the Study:
- To evaluate the effectiveness of ascorbic acid pretreatment in preventing CIN.
- To assess the impact of ascorbic acid on renal function in patients with pre-existing renal insufficiency.
- To determine if short-term, high-dose ascorbic acid administration reduces CIN risk.
Main Methods:
- A prospective, randomized, controlled trial was conducted.
- 156 patients with chronic renal insufficiency (eGFR < 60 mL/min/1.73 m² or serum creatinine ≥ 1.1 mg/dL) were enrolled.
- Patients received either intravenous ascorbic acid followed by oral supplementation or a placebo (sodium chloride), alongside standard hydration.
Main Results:
- No significant difference was observed in the mean peak serum creatinine increase within 48 hours post-procedure between the ascorbic acid group (0.012±0.146 mg/dL) and the control group (0.022±0.212 mg/dL).
- The incidence of CIN (defined as ≥25% or ≥0.5 mg/dL increase in serum creatinine) was similar: 5.4% in the ascorbic acid group versus 6.3% in the control group (p=0.690).
- In-hospital clinical outcomes and length of hospital stay did not differ between the groups.
Conclusions:
- Short-term, high-dose ascorbic acid pretreatment does not prevent renal function deterioration after contrast medium administration.
- Ascorbic acid is not effective in reducing the risk of contrast-induced nephropathy in patients with baseline renal insufficiency undergoing coronary angiography.
- Further research may be needed to explore alternative strategies for CIN prevention in this patient population.
Background:
Some studies have shown that antioxidant ascorbic acid has renal protective effects, but the beneficial effects of contrast-induced nephropathy prevention remain to be clearly shown. Therefore, we aimed to determine whether ascorbic acid pretreatment reduces the risk of contrast-induced nephropathy in a high-risk population of patients with renal insufficiency undergoing coronary angiography.
Methods:
We conducted a prospective, randomized, controlled trial, involving 156 consecutive patients with chronic renal insufficiency (calculated estimated glomerular filtration rate<60 mL/min/1.73 m(2) and/or serum creatinine≥1.1 mg/dL) undergoing coronary angiography. Patients were randomized to ascorbic acid (n=74, 3 g intravenous injection before the procedure and oral 1 g per day for 2 days after the procedure, ascorbic acid group) or sodium chloride alone (n=82, control group). All patients received pre-and postprocedure hydration.
Results:
There was no difference between the ascorbic acid group and control group in mean peak increase in serum creatinine measured within 48 hours after coronary angiography, the primary study end point (0.012±0.146 vs 0.022±0.212 mg/dL respectively, p=0.216). The incidence of contrast-induced nephropathy, a secondary end point defined as increase of either≥25% or ≥0.5 mg/dL in serum creatinine, was 5.4% in ascorbic acid-treated patients (4/74) and 6.3% in control group patients (6/82), a nonsignificant difference (p=0.690). There were also no differences between the 2 groups in the inhospital clinical outcomes or length of hospital stay.
Conclusion:
Ascorbic acid pretreatment for short-term at high dose do not prevent renal function deterioration after administration of contrast medium in patients with baseline renal insufficiency undergoing coronary angiography.
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