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New strategy of α- and γ-tocopherol to prevent contrast-induced acute kidney injury in chronic kidney disease patients undergoing elective coronary procedures.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (2013-01-15)
Adis Tasanarong, Anchalee Vohakiat, Pisit Hutayanon, Dilok Piyayotai
ABSTRACT

Contrast-induced acute kidney injury (CI- AKI) increases the likelihood of patient morbidity and mortality following coronary procedures. Volume supplement with saline is the standard treatment to prevent CI-AKI. Additional antioxidant prophylaxis has often yielded conflicting results. The present study was conducted to examine the role of novel application vitamin E (tocopherol) in preventing CI-AKI. This prospective, double-blind, randomized and placebo-controlled trial was carried out in 305 patients with chronic kidney disease (CKD) undergoing coronary procedures. All patients were randomly assigned to prophylaxis administration with 0.9% saline infusions plus daily oral medication comprised of either (i) placebo (n = 101), (ii) α-tocopherol (n = 102) or (iii) γ-tocopherol (n = 102) starting 5 days before and ending 2 days after coronary procedures. The CI-AKI risk score of each patient was calculated. All coronary procedures were performed using a low-osmolar, non-ionic contrast agent. CI-AKI developed in 14.9% in the placebo group, 4.9% in the α-tocopherol group (P = 0.02 versus the placebo group) and 5.9% in the γ-tocopherol group (P = 0.04 versus the placebo group). In patients with diabetes, hypertension, anaemia, aged over 55 years, male gender or with contrast agent dosages >120 mL, α-tocopherol showed a larger effect than γ-tocopherol when compared with the placebo group (P < 0.05). Prophylaxis administration with oral α- or γ-tocopherol in combination with 0.9% saline is effective in protecting against CI-AKI in CKD patients undergoing elective coronary procedures.

MATERIALS
Product Number
Brand
Product Description

Supelco
Tocopheryl Acetate, a, Pharmaceutical Secondary Standard; Certified Reference Material
Sigma-Aldrich
DL-α-Tocopherol acetate, ≥96% (HPLC)
Supelco
DL-alpha-Tocopherol acetate, analytical standard
Sigma-Aldrich
(+)-α-Tocopherol, from vegetable oil, Type V, ~1000 IU/g
α-Tocopherol acetate, European Pharmacopoeia (EP) Reference Standard
Sigma-Aldrich
DL-α-Tocopherol acetate, tested according to Ph. Eur.
Sigma-Aldrich
(+)-α-Tocopherol, Type VI, from vegetable oil, liquid (≥0.88M based on potency, density and molecular wt.), BioReagent, suitable for insect cell culture, ≥1000 IU/g
All-rac-alpha-tocopheryl acetate for peak identification, European Pharmacopoeia (EP) Reference Standard