Does Ascorbic Acid Protect Against Contrast-Induced Acute Kidney Injury in Patients Undergoing Coronary Angiography

Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. Electronic address: .
Journal of the American College of Cardiology (Impact Factor: 16.5). 08/2013; 62(23). DOI: 10.1016/j.jacc.2013.07.065
Source: PubMed


To perform a systematic review with meta-analysis of randomized controlled trials (RCTs) comparing the use of ascorbic acid with placebo or other treatment options against contrast induced-acute kidney injury (CI-AKI) in patients undergoing coronary angiography.
CI-AKI remains the most widely discussed and debated topic in cardiovascular medicine with its incidence on a rise due to an increasing number of contrast media-enhanced radiological procedures being performed.
Medline, Embase and Cochrane central databases were searched from inception to May 2013, without language restrictions. For a study to be selected, it had to report the incidence of CI-AKI as an outcome measure. Studies were excluded if at least one study arm did not have ascorbic acid administered alone or with saline hydration. Data was extracted by 1 author and random checks were made by a co-author.
Nine RCTs reported data on the incidence of CI-AKI in 1536 patients who had completed the trial and were included in the final analysis. Patients receiving ascorbic acid had 33% less risk of CI-AKI compared to patients receiving placebo or alternate pharmacological treatment [risk ratio (RR) by random effects model: 0.672 (95% CI: 0.466-0.969), p=0.034].
Ascorbic acid provides effective nephroprotection against CI-AKI and may form a part of effective prophylactic pharmacological regimens.

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    • "The incidence in contrast-induced nephrotoxicity was 9% in the ascorbic acid group and 20% in the placebo group (P = 0.02). In a recently published meta-analysis Sadat et al. showed that in 1536 patients, who completed the trial, ascorbic acid produced a 33% lower risk of developing a CIN [63]. So ascorbic acid might be a form of prophylactic regime in contrast media induced renal failure; nevertheless it has not been recommended by the CM safety committee. "
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    ABSTRACT: Contrast-induced nephrotoxicity (CIN) is a form of acute kidney injury that follows intravascular contrast media exposure. CIN may be preventable because its risk factors are well established and the timing of renal insult is commonly known in advance. However, contrast-induced nephrotoxicity is still the third leading cause of iatrogenic renal failure. This important complication accounts up to 10% of acute renal failure cases in hospitalized patients and it is associated with increased short- and long-term morbidity and mortality. Prolonged hospitalization follows and overall increases healthcare resource utilization. This paper will discuss the various prophylactic procedures tested in clinical trials.
    04/2014; 2014:308316. DOI:10.1155/2014/308316
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    ABSTRACT: Acute kidney injury (AKI) is a common medical problem, especially in patients undergoing cardiovascular procedures. The risk of kidney damage has multiple determinants and is often related to or exacerbated by intravenous or intra-arterial iodinated contrast. Contrast-induced AKI (CI-AKI) has been associated with an increased risk of subsequent myocardial infarction, stroke, the development of heart failure, rehospitalization, progression of chronic kidney disease, end-stage renal disease, and death. Statins have been studied extensively in the setting of chronic kidney disease and they have been shown to reduce albuminuria, but they have had no effect on the progressive reduction of glomerular filtration or the need for renal replacement therapy. Several meta-analyses have shown a protective effect of short-term statin administration on CI-AKI and led to two large randomized controlled trials evaluating the role of rosuvastatin in the prevention of CI-AKI in high-risk patients with acute coronary syndrome and diabetes mellitus. Both trials showed a benefit of rosuvastatin prior to contrast administration in a statin-naive patient population. In aggregate, these studies support the short-term use of statins specifically for the prevention of CI-AKI in patients undergoing coronary angiography with or without percutaneous coronary intervention. © 2014 S. Karger AG, Basel.
    Journal of the American College of Cardiology 08/2013; 127(1-4). DOI:10.1016/j.jacc.2013.07.066 · 16.50 Impact Factor
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    ABSTRACT: Contrast-induced acute kidney injury (CI-AKI) is one of the most widely discussed and debated topics in cardiovascular medicine. With increasing number of contrast-media- (CM-) enhanced imaging studies being performed and growing octogenarian population with significant comorbidities, incidence of CI-AKI remains high. In this review, pathophysiology of CI-AKI, its relationship with different types of CM, role of serum and urinary biomarkers for diagnosing CI-AKI, and various prophylactic strategies used for nephroprotection against CI-AKI are discussed in detail.
    09/2013; 2013. DOI:10.5402/2013/496438
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Ammara Usman