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Prevention of contrast‐induced nephropathy with single bolus erythropoietin in patients with diabetic kidney disease: A randomized controlled trial
Author(s) -
ShemaDidi Lilach,
Kristal Batya,
Eizenberg Sarit,
Marzuq Nabil,
Sussan Majdy,
FeldmanIdov Yulie,
Ofir Pnina,
Atar Shaul
Publication year - 2016
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12609
Subject(s) - medicine , contrast induced nephropathy , kidney disease , nephropathy , percutaneous coronary intervention , creatinine , gastroenterology , cystatin c , incidence (geometry) , prospective cohort study , acute kidney injury , erythropoietin , population , urology , anemia , diabetes mellitus , myocardial infarction , endocrinology , physics , environmental health , optics
Aim Contrast‐induced‐nephropathy (CIN) is associated with poor outcomes, thus prevention of CIN may be of clinical value. Erythropoietin (EPO) has been shown to elicit tissue‐protective effects in experimental models and in clinical studies of acute kidney injury. We therefore evaluated its effectiveness for prevention of CIN after coronary angiography (CA) ± percutaneous coronary intervention (PCI) in diabetic patients with chronic kidney disease. Methods A prospective, randomized, controlled trial was carried out in 138 diabetic patients with eGFR <60mL/min who underwent non‐urgent CA ± PCI. Patients received normal saline and n‐acetyl cysteine before CA, with or without 50 000 U of EPO administered 30 min prior to CA. CIN was defined as an increase in serum creatinine of at least 0.5 mg/dL during the first 2 days after exposure to contrast media. Primary outcome was the incidence of CIN. Secondary outcomes were the sensitivity and positive predictive value (PPV) of Cystatin C (CC) and Neutrophil‐gelatinase‐associated‐lipocalin (NGAL) for diagnosis of CIN. Results The observed incidence of CIN was 8.7%, significantly lower than the expected for such high‐risk population. The administration of EPO prior to CA did not reduce the incidence of CIN (9.7% vs. 7.6%, P = 0.65). CC and NGAL demonstrated a low sensitivity (16.6%) and low PPV (6.7 and 33.3%, respectively) for detecting CIN. Conclusion The administration of EPO prior to CA did not reduce the incidence of CIN. Additional prospective research with a larger sample size and in other patient categories is essential to further define the potential protective effect of EPO on prevention of CIN.