Iranian Heart Journal

Iranian Heart Journal

Intravenous Vitamin C to Prevent Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention

Document Type : Original Article

Authors
Farzaneh Futuhi 1
Mahshid Malakootian 2
Majid Maleki 3
Mohammad Mehdi Peighambari 3
Maryam Hosseini Moghadam 2
Mohammad Javad Hosseini 3
Shabnam Boudagh 3
Maedeh Arabian 3
1 Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
2 Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
3 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Abstract
Background: This retrospective cohort study aimed to evaluate the effects of the intravenous administration of vitamin C before and after exposure to the contrast medium for the prophylaxis of contrast-induced nephropathy (CIN) in patients undergoing coronary angiography.
 
Methods: Data on 210 patients with chronic kidney disease (CKD) (defined as an estimated glomerular filtration rate ≤60 mL/min/1.73m2) were obtained through medical chart reviews and electronic data in 3 different groups: 1) no vitamin C administered, 2) vitamin C administered 30 minutes before angiography, and 3) vitamin C administered 30 minutes after angiography. Each group consisted of 70 patients, and vitamin C was administered intravenously. CIN incidence in all the groups was defined as an increase of 0.5 mg/dL or 25% in serum creatinine levels.
 
Results: Overall, CIN incidence was significantly lower in patients who received intravenous vitamin C before (P≤0.05) and after (P≤0.05) angiography than in patients with no prophylaxis. The post-angiography administration of vitamin C was very effective in diminishing creatinine rise and preventing CIN. CIN occurred in 7.1% of the patients in the pre-administered and post-administered groups.
 
Conclusions: The intravenous administration of vitamin C before and after angiography could effectively decrease CIN incidence in patients undergoing percutaneous coronary intervention. The post-angiography administration of vitamin C is more effective to decrease serum creatinine levels. (Iranian Heart Journal 2022; 23(1): 149-159)
Keywords
Contrast-induced nephropathy
Chronic kidney disease
Coronary angiography
Vitamin C
Antioxidant
  1. Brown JR, Thompson CA. Contrast-induced acute kidney injury: the at-risk patient and protective measures. Curr Cardiol Rep. 2010; 12(5):440-5.
  2. Maeder M, Klein M, Fehr T, Rickli H. Contrast nephropathy: review focusing on prevention. J Am Coll Cardiol. 2004; 44(9):1763-71.
  3. Hong WY, Kabach M, Feldman G, Jovin IS. Intravenous fluids for the prevention of contrast-induced nephropathy in patients undergoing coronary angiography and cardiac catheterization. Expert Rev Cardiovasc Ther. 2020; 18(1):33-9.
  4. Morcos R, Kucharik M, Bansal P, Al Taii H, Manam R, Casale J, et al. Contrast-Induced Acute Kidney Injury: Review and Practical Update. Clin Med Insights Cardiol. 2019;13:1179546819878680.
  5. Khajali F, Khajali Z. L-carnitine supplementation decreases lipid peroxidation and improves cardiopulmonary function in broiler chickens reared at high altitude. Acta Vet Hung. 2014;62(4):489-99.
  6. Firouzi A, Eshraghi A, Shakerian F, Sanati HR, Salehi N, Zahedmehr A, et al. Efficacy of pentoxifylline in prevention of contrast-induced nephropathy in angioplasty patients. Int Urol Nephrol. 2012;44(4):1145-9.
  7. Laroussi L, Triki M, Ibn Elhaj Z, Ben Halima A, Boukhris M, Ben Amara W, et al. [Vitamin C+sodium bicarbonate versus sodium bicarbonate alone in preventing contrast-induced nephropathy]. Ann Cardiol Angeiol (Paris). 2017;66(4):190-6.
  8. Sadat U, Usman A, Gillard JH, Boyle JR. Does ascorbic acid protect against contrast-induced acute kidney injury in patients undergoing coronary angiography: a systematic review with meta-analysis of randomized, controlled trials. J Am Coll Cardiol. 2013;62(23):2167-75.
  9. Pisani A, Riccio E, Andreucci M, Faga T, Ashour M, Di Nuzzi A, et al. Role of reactive oxygen species in pathogenesis of radiocontrast-induced nephropathy. Biomed Res Int. 2013;2013:868321.
  10. Ali-Hasan-Al-Saegh S, Mirhosseini SJ, Ghodratipour Z, Sarafan-Chaharsoughi Z, Dehghan AM, Rahimizadeh E, et al. Protective effects of anti-oxidant supplementations on contrast-induced nephropathy after coronary angiography: an updated and comprehensive meta-analysis and systematic review. Kardiol Pol. 2016;74(7):610-26.
  11. Azzalini L, Laricchia A, Regazzoli D, Mitomo S, Hachinohe D, Bellini B, et al. Ultra-Low Contrast Percutaneous Coronary Intervention to Minimize the Risk for Contrast-Induced Acute Kidney Injury in Patients With Severe Chronic Kidney Disease. J Invasive Cardiol. 2019.
  12. Atanda AC, Olafiranye O. Contrast-induced acute kidney injury in interventional cardiology: Emerging evidence and unifying mechanisms of protection by remote ischemic conditioning. Cardiovasc Revasc Med. 2017;18(7):549-53.
  13. Wybraniec MT, Bozentowicz-Wikarek M, Chudek J, Mizia-Stec K. Pre-procedural renal resistive index accurately predicts contrast-induced acute kidney injury in patients with preserved renal function submitted to coronary angiography. Int J Cardiovasc Imaging. 2017;33(5):595-604.
  14. Duan C, Cao Y, Liu Y, Zhou L, Ping K, Tan MT, et al. A New Preprocedure Risk Score for Predicting Contrast-Induced Acute Kidney Injury. Can J Cardiol. 2017;33(6):714-23.
  15. Kang X, Hu DY, Li CB, Ai ZS, Peng A. N-acetylcysteine for the prevention of contrast-induced nephropathy in patients with pre-existing renal insufficiency or diabetes: a systematic review and meta-analysis. Ren Fail. 2015;37(10):297-303.
  16. Li Y, Liu Y, Shi D, Yang L, Liang J, Zhou Y. Insulin Resistance Increases the Risk of Contrast-Induced Nephropathy in Patients Undergoing Elective Coronary Intervention. Angiology. 2016;67(2):139-45.
  17. Stolker JM, McCullough PA, Rao S, Inzucchi SE, Spertus JA, Maddox TM, et al. Pre-procedural glucose levels and the risk for contrast-induced acute kidney injury in patients undergoing coronary angiography. J Am Coll Cardiol. 2010;55(14):1433-40.
  18. Heunisch F, Chaykovska L, von Einem G, Alter M, Dschietzig T, Kretschmer A, et al. ADMA predicts major adverse renal events in patients with mild renal impairment and/or diabetes mellitus undergoing coronary angiography. Medicine (Baltimore). 2017;96(6):e6065.
  19. Barbieri L, Verdoia M, Schaffer A, Cassetti E, Di Giovine G, Marino P, et al. Pre-diabetes and the risk of contrast induced nephropathy in patients undergoing coronary angiography or percutaneous intervention. Diabetes Res Clin Pract. 2014;106(3):458-64.
  20. Yang JQ, Ran P, Chen JY, He YT, Li LW, Tan N, et al. Development of contrast-induced acute kidney injury after elective contrast media exposure in patients with type 2 diabetes mellitus: effect of albuminuria. PLoS One. 2014;9(9):e106454.
  21. Feng Y, Huang X, Li L, Chen Z. N-acetylcysteine versus ascorbic acid or N-acetylcysteine plus ascorbic acid in preventing contrast-induced nephropathy: A meta-analysis. Nephrology (Carlton). 2018;23(6):530-8.
  22. Sharp AJ, Patel N, Reeves BC, Angelini GD, Fiorentino F. Pharmacological interventions for the prevention of contrast-induced acute kidney injury in high-risk adult patients undergoing coronary angiography: a systematic review and meta-analysis of randomised controlled trials. Open Heart. 2019;6(1):e000864.
  23. Miyazawa T, Matsumoto A. Determination of cellular vitamin C dynamics by HPLC-DAD. 2019.
  24. Subramaniam RM, Wilson RF, Turban S, Suarez-Cuervo C, Zhang A, Sherrod C, et al. AHRQ Comparative Effectiveness Reviews. Contrast-Induced Nephropathy: Comparative Effectiveness of Preventive Measures. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016.
  25. Navarese EP, Gurbel PA, Andreotti F, Kolodziejczak MM, Palmer SC, Dias S, et al. Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures-a systematic review and network meta-analysis. PLoS One. 2017;12(2):e0168726.
  26. Palli E, Makris D, Papanikolaou J, Garoufalis G, Tsilioni I, Zygoulis P, et al. The impact of N-acetylcysteine and ascorbic acid in contrast-induced nephropathy in critical care patients: an open-label randomized controlled study. Crit Care. 2017;21(1):269.
  27. Komiyama K, Ashikaga T, Inagaki D, Miyabe T, Arai M, Yoshida K, et al. Sodium Bicarbonate-Ascorbic Acid Combination for Prevention of Contrast-Induced Nephropathy in Chronic Kidney Disease Patients Undergoing Catheterization. Circ J. 2017;81(2):235-40.
  28. Liu LY, Liu Y, Wu MY, Sun YY, Ma FZ. Efficacy of atorvastatin on the prevention of contrast-induced acute kidney injury: a meta-analysis. Drug Des Devel Ther. 2018;12:437-44.
  29. Hossain MA, Costanzo E, Cosentino J, Patel C, Qaisar H, Singh V, et al. Contrast-induced nephropathy: Pathophysiology, risk factors, and prevention. Saudi J Kidney Dis Transpl. 2018; 29(1):1-9.
  30. Bakris GL, Lass N, Gaber AO, Jones JD, Burnett JC, Jr. Radiocontrast medium-induced declines in renal function: a role for oxygen free radicals. Am J Physiol. 1990; 258(1 Pt 2):F115-20.
  31. Vlachopanos G, Schizas D, Hasemaki N, Georgalis A. Pathophysiology of Contrast-Induced Acute Kidney Injury (CIAKI). Curr Pharm Des. 2019;25(44):4642-7.
  32. Seeliger E, Sendeski M, Rihal CS, Persson PB. Contrast-induced kidney injury: mechanisms, risk factors, and prevention. Eur Heart J. 2012;33(16):2007-15.
  33. Cox CD, Tsikouris JP. Preventing contrast nephropathy: what is the best strategy? A review of the literature. J Clin Pharmacol. 2004;44(4):327-37.
  34. Ward DB, Valentovic MA. Contrast Induced Acute Kidney Injury and Direct Cytotoxicity of Iodinated Radiocontrast Media on Renal Proximal Tubule Cells. J Pharmacol Exp Ther. 2019;370(2):160-71.
Iranian Heart Journal
Volume 23, Issue 1
Winter 2022
Pages 149-159