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Vitamins for Prevention of Contrast-induced Acute Kidney Injury: A Systematic Review and Trial Sequential Analysis

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Abstract

Background

To date, universally accepted preventive measures for contrast-induced acute kidney injury (CI-AKI) do not exist, and they warrant further research.

Objective

The purpose of this study was to evaluate the efficacy of vitamins, including vitamin C and E, for prevention of CI-AKI.

Methods

We electronically searched the MEDLINE, EMBASE, and Cochrane databases. The outcome of interest was the incidence of CI-AKI.

Results

A total of 19 studies were included in this meta-analysis. Pooled analysis showed that vitamin C plus saline [relative risk (RR) = 0.63, 95% confidence interval (CI) 0.49–0.82, p = 0.0005] and vitamin E plus saline (RR = 0.39, 95% CI 0.24–0.62, p < 0.0001) significantly reduced the incidence of CI-AKI compared to saline alone. The effect of vitamin C plus saline was further confirmed by trial sequential analysis (TSA). However, TSA indicated that more trials are required to confirm the efficacy of vitamin E plus saline. There was no significant difference in preventing CI-AKI between vitamin C and N-acetylcysteine (NAC) (RR = 0.90, 95% CI 0.47–1.71, p = 0.75), between vitamin C plus NAC and saline (RR = 0.62, 95% CI 0.30–1.30, p =  0.20), as well as between vitamin C plus NAC and NAC (RR = 0.97, 95% CI 0.49–1.92, p = 0.93).

Conclusions

Vitamin C plus saline administration is effective at reducing the risk of CI-AKI. Evidence for the use of vitamin E plus saline in this context is encouraging, but more trials are required. Furthermore, this meta-analysis and TSA indicated insufficient power to draw a definitive conclusion on the effect of vitamin C plus NAC, versus saline or NAC alone, which needs to be explored further.

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Acknowledgements

The English in this document has been checked by at least two professional editors, both native speakers of English, from Textcheck Scientific and Technical Editing Service.

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Authors and Affiliations

  1. Department of Nephrology, the 306th Hospital of Chinese PLA, 9 AnXiangBeiLi Road, Beijing, 100101, China

    Yongxing Xu, Boran Liang & Jianjun Gao

  2. Department of Nephrology, The Hospital of Shunyi District Beijing, No.3 Guangming South Street, Shunyi District, Beijing, China

    Xinming Zheng

  3. Department of Endocrinology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, 100853, China

    Zhaoyan Gu

  4. Healthcare Department, Hainan Branch of Chinese of PLA General Hospital, Sanya, 527400, China

    Zhaoyan Gu

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  1. Yongxing Xu
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Contributions

Research idea and study design: YX, JG, XZ; data acquisition: ZG, JG; data analysis/interpretation: ZG, JG, YX; statistical analysis: YX; the writing of the paper: ZG, XZ, BL; supervision or mentorship: JG, YX.

Corresponding authors

Correspondence to Jianjun Gao or Zhaoyan Gu.

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Funding

This study was supported in part by Hainan Natural Science Foundation of China to Z.Y.G (No.20168350) and Sanya Medical and Health Science and Technology Innovation Project of China to Z.Y.G (No. 2015YW24).

Conflict of Interest

Yongxing Xu, Xinming Zheng, Boran Liang, Jianjun Gao and Zhaoyan Gu declare that they have no conflicts of interest that might be relevant to the contents of this manuscript.

Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was not involved.

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Xu, Y., Zheng, X., Liang, B. et al. Vitamins for Prevention of Contrast-induced Acute Kidney Injury: A Systematic Review and Trial Sequential Analysis. Am J Cardiovasc Drugs 18, 373–386 (2018). https://doi.org/10.1007/s40256-018-0274-3

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