Prevention of contrast-induced nephropathy with ascorbic acid

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.