Protective effects of anti-oxidant supplementations on contrast induced nephropathy after coronary angiography: an updated and comprehensive meta-analysis and systematic review.

Sadegh Ali-Hassan-Sayegh, Seyed Jalil Mirhosseini, Zahra Ghodratipour, Zahra Sarafan-Chaharsoughi, Ali Mohammad Dehghan, Elham Rahimizadeh, Azadeh Shahidzadeh, Mohammad Reza Lotfaliani, Farbod Sedaghat-Hamedani, Elham Kayvanpour, Anton Sabashnikov, Aron-Frederik Popov,

Kardiologia polska, January 18, 2016

This systematic review with meta-analysis sought to determine the strength of evidence for effects of antioxidants (AO) such as N-acetyl cysteine (NAC), vitamin C, vitamin E, and alpha-lipoic acid on the incidence of CIN, requirement for hemodialysis, level of serum creatinine, and mortality after coronary angiography. After Medline, Embase, Elsevier, Sciences online database and Google scholar literature search, studies with randomized controlled design were selected for the meta-analysis. The effect sizes measured were odds ratio (OR) for categorical variable and standard mean difference (SMD) with 95% confidence interval for calculating differences between mean changes of serum creatinine in intervention and control groups. A value of P< 0.1 for Q test or I2 >50% indicated significant heterogeneity between the studies. Literature search of all major databases retrieved 2350 studies. After screening, a total of 49 trials were identified that reported outcomes. Pooled treatment effect analysis revealed that NAC (OR of 0.79; 95% CI: 0.69-0.9; P=0.000), vitamin C (0.63 (95% CI: 0.45-0.89; P=0.000), and vitamin E (OR of 0.5; 95% CI: 0.27-0.92; P=0.026) could significantly reduce the incidence of CIN. NAC (SMD of -0.119; 95% CI: -0.191 to -0.046; P=0.000), but not vitamin C (SMD of -0.08; 95% CI: -0.22 to 0.04; P=0.1) and vitamin E (-0.25; 95% CI: -0.46 to -0.05; P=0.1) could significantly reduce mean level of serum creatinine Nevetheless, AO could not reduce the incidence of mortality with an OR of 0.94 (95% CI: 0.69-1.28; P=0.7). Overall, antioxidants such as NAC, vitamin C, and vitamin E may reduce the incidence of CIN, while only NAC might be able to significantly lower serum creatinine levels. There is no impact of of anti-oxidant supplementation on mortality.

Pubmed Link: 26779856

DOI: 10.5603/KP.a2016.0007