Comparing the Effect of Vitamin E and N-Acetylcysteineon Prevention of Contrast-Induced Nephropathy in Dia-betic Patients under Coronary Angiography

Considering the incidence of contrast induced nephropathy (CIN) as well as its complicationsand costs, prevention and reducing the risk of CIN is an essential issue. The present study aimed to evaluatethe efficacy of vitamin E and N-acetylcysteine (NAC) on the prevention of CIN in diabetic patients undergo-ing coronary angiography.

360 patients with diabetes who required angiography, including patientswith stable angina susceptible to acute myocardial infarction and patients with acute coronary syndrome wereincluded and randomized into three groups . Group 1 received serum therapy (Normal Saline) plus NAC andplacebo of vitamin E, group 2 received serum therapy plus vitamin E and placebo of NAC, and group 3 onlyreceived serum therapy with two placebos of NAC and vitamin E. The groups were compared considering CINafter angiography.

A total of 93 patients were studied in group 1, 94 in group 2, and 113 in group 3. CINoccurred in 4 patients (4.3%), 4 patients (4.3%), and 8 patients (7.1%) in groups 1, 2, and 3, respectively (P=0.58).There was a significant difference in mean difference of creatinine levels before and after study in groups 1 and 2(both P<0.001). In the subgroup of patients with chronic kidney disease, NAC significantly reduced CIN (P=0.03).

The results suggested efficacy of both interventions, considering reduction of mean Serum crea-tinine ( Scr) after the study, while lack of significant difference in the incidence of CIN could be because of thelow number of CIN in our study. The second important finding of this study, probably the reduced risk of CINin diabetic patients with chronic kidney disease receiving NAC, recommends the use of NAC for prevention ofCIN, especially in this subgroup of patients undergoing angiography