Vitamins for Prevention of Contrast-induced Acute Kidney Injury: A Systematic Review and Trial Sequential Analysis
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To date, universally accepted preventive measures for contrast-induced acute kidney injury (CI-AKI) do not exist, and they warrant further research.
The purpose of this study was to evaluate the efficacy of vitamins, including vitamin C and E, for prevention of CI-AKI.
We electronically searched the MEDLINE, EMBASE, and Cochrane databases. The outcome of interest was the incidence of CI-AKI.
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).
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.
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.
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.
Compliance with Ethical Standards
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.
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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