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KMID : 0928520110210020076
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Korean Journal of Lipidology
2011 Volume.21 No. 2 p.76 ~ p.85
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Alpha-Lipoic Acid for the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography - A Prospective Randomized Trial: Interim-analysis
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Jo Sang-Ho
Kim Sung-Ai
Kim Hyun-Sook
Han Sang-Jin
Park Woo-Jung
Rim Chong-Yun
Choi Young-Jin
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Abstract
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Background: N-acetylcysteine and ascorbic acid have been reported to be efficacious in preventing contrast induced nephropathy (CIN) after coronary angiography through their antioxidants property. However there have been many controversies regarding their role. We evaluated the efficacy of widely used antioxidant- alpha lipoic acid (ALA) for prevention of CIN.
Methods: We conducted a prospective randomized controlled trial to evaluate the efficacy of ALA in CIN prevention. One hundred and sixty seven patients with basal renal insufficiency (creatinine clearance [CrCl] <60 mL/min) were randomized to have ALA for 2 days (600 mg orally three times a day before and after coronary catheterization, totally 3,600 mg, n=81) or control (n=86). All the patients received hydration with iso-tonic saline at a rate of 1 mL/kg/hour at least for 12 hours before and after administration of contrast agent. Only iso- or low- osmolar contrast media were used in the procedure. The primary end point was the incidence of CIN and the secondary end point was the peak increase of serum creatinine (SCr) within two days. CIN was defined as an increase in SCr of either ≥25% or ≥0.5 mg/dL.
Results: There were no differences in age, sex, prevalence of diabetes, prevalence of hypertension, baseline SCr, baseline left ventricular systolic function, and contrast media dose. The incidence of CIN was similar in both groups, 3.7% vs. 5.8% for ALA and placebo group (P=0.1). The mean peak increase of SCr was not different in ALA and placebo group (-0.01±0.32 mg/dL vs. -0.05±0.22 mg/mL, respectively [P=0.355]). The SCr did not change from baseline of 1.25 mg/dL to 1.24 mg/dL (P=0.902) within 2 days in the ALA group and in the simple saline hydration group (from 1.21 mg/dL to 1.16 mg/dL, P=0.825).
Conclusion: We found for the first time that alpha lipoic acid or a well known antioxidant may not be beneficial in CIN prevention. This study may imply that not all antioxidants are preventive for CIN in patients undergoing coronary angiography.
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KEYWORD
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Antioxidant, Alpha-lipoic acid, Contrast induced nephropathy, Prevention
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