Alpha-tocopherol and contrast-induced nephropathy: A meta-analysis of randomized controlled trials

Author:

Monami Matteo1,Cignarelli Angelo2,Pinto Sara3,D’Onofrio Luca4,Milluzzo Agostino5,Miccoli Roberto6,Penno Giuseppe6,Mannucci Edoardo1

Affiliation:

1. Diabetology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy

2. Department of Emergency and Organ Transplantation, Section on Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy

3. Postgraduate School of Endocrinology and Metabolism, University of Pavia, Italy

4. Department of Experimental Medicine, Sapienza University, Rome

5. Endocrinology Section, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy

6. Department of Clinical and Experimental Medicine, Section of Diabetes and Metabolic Diseases, University of Pisa – Cisanello Hospital, Pisa, Italy

Abstract

Abstract. Background: Contrast–induced nephropathy (CIN) is a relevant cause of acute renal dysfunction and is associated with an increased morbidity and mortality. Purpose: Verify the effect of α-tocopherol pre-treatment on CIN prevention in subjects with chronic kidney disease. Methods: A Medline/Embase and clinicaltrials.gov were searched up to May 1st, 2017. Randomized controlled trials recruiting patients undergoing diagnostic or therapeutic radiocontrast infusion comparing the effect of either oral or i.v. multiple administration of pharmacological dose of α-tocopherol in preventing CIN versus placebo were included. A random-effects model, calculating Mantel-Haenszel odds ratio with 95% confidence interval, was applied to study the effect of α-tocopherol on CIN occurrence. Funnel plot analysis was used to assess publication bias, while agreement within studies was measured by the I2 index and tested with the Q-Cochran test. Results: Out of 242 studies, 4 trials were selected. CIN incidence resulted significantly lower in α-tocopherol compared to placebo group (5.8% vs. 15.4%, MH-OR [95% C.I.] 0.34 [0.19 – 0.59]). Alpha-tocopherol treatment was associated with both a tendential higher eGFR (mean difference 2.19 [95% C.I. -0.41; 4.79] mL/min) and lower creatinine level (mean difference −0.06 [95% C.I. −0.21; 0.09] mg/dl) compared to placebo. No relevant publication bias (p = 0.48) and heterogeneity (I2 = 0%; χ2 = 1.01, df = 3 [p = 0.80], I2 = 0%) were evident. Conclusions: Alpha-tocopherol pre-treatment is associated with reduction of incidence of CIN. Its administration deserves to be further explored as a simple and inexpensive tool for CIN prevention.

Publisher

Hogrefe Publishing Group

Subject

Nutrition and Dietetics,General Medicine,Endocrinology, Diabetes and Metabolism,Medicine (miscellaneous)

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