Coronary Angiography: Vitamin C and Protection Against Contrast-Induced Kidney Disease

MedicalResearch.com Interview with:
Umar Sadat, MD, PhD
Addenbrooke’s Hospital
Cambridge, United Kingdom

MedicalResearch.com: What are the main findings of the study?

Dr. Sadat: Vitamin C offers significant nephroprotection against contrast induced-acute kidney injury (CI-AKI) in patients undergoing coronary angiography.
Patients receiving Vitamin C were observed to have 33% less risk of CI-AKI compared to those receiving placebo or other treatment.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Sadat: The robustness of this meta-analysis was evident at every step, which though unexpected was very reassuring too. This makes the results of this meta-analysis very reliable.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Sadat: Although most clinical trials have investigated the use of N-acetylcysteine against CI-AKI, there is lack of convincing and consistent evidence about its use. Although our meta analysis is the first ever pooled analysis of randomized controlled trials assessing nephroprotective role of vitamin C against CI-AKI, the robustness of our meta analysis should encourage clinicians to use this pharmacological agent to protect against CI-AKI in patients undergoing contrast media-enhanced radiological procedures, particularly in those with pre existing renal impairment.

For patients, our results may be very reassuring and encouraging in that vitamin C can protect their kidneys from dye-induced kidney damage, particularly when there is pre existing impairment of kidney functions.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Sadat: Future studies should aim at investigating the underlying mechanisms involved in the nephroprotective role of vitamin C against CI-AKI.

Our meta-analysis included patients who were undergoing coronary angiography. Future studies may include patients undergoing peripheral angiography such as patients with peripheral vascular disease, or patients undergoing endovascular aortic procedures such as endovascular aortic aneurysm repair (EVAR).

All such future studies should be adequately powered and use validated biomarkers of renal injury, rather than use non-validated renal biomarkers-changes in which may not translate into clinically relevant outcomes.

 

Citation:

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.

Umar Sadat, MD, PhD; Ammara Usman, MB BS, MBA; Jonathan H. Gillard, MD, FRCR; Jonathan R. Boyle, MD, FRCS

J Am Coll Cardiol. 2013;():. doi:10.1016/j.jacc.2013.07.065