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Ascorbic Acid and Contrast-induced Kidney Injury

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CSWN talks with Umar Sadat, MD, of Cambridge University Hospitals, UK, about a new systematic review with meta-analysis of randomized clinical trials examining ascorbic acid and potential contrast-induced kidney injury. This interview was conducted at TCT 2013 in San Francisco.

Coming up in jack we’re going to be taking a look at the topic ascorbic acid and protection against contrast induced kidney injury and i’m with dr. umar sadat md and phd from cambridge in the uk and this is a fascinating paper i mean we’re talking about ascorbic acid does it protect against contrast induced acute kidney injury and what you’ve done is you’ve

Actually taken a meta-analysis of all kinds of trials first off why did you do this what got your interest i mean we’re looking for the for that pharmacological agent which can reduce the incidence of contrast in the property we don’t have any pharmacological agent up-to-date the only medication that we normally use is normal saline or intravenous hydration so

We’re looking for that pharmacological agent which can help us reduce the incidence and vitamin c has never been explored before in a meta-analysis so we thought for looking at evidence from literature and see what evidence comes from it when you first looked and saw that ascorbic acid was being used or at least evaluated in this did you get excited over the

Concept of this is a pretty simple approach if it worked it was pretty unbelievable you know i mean you’d never expect ascorbic acid being used as a medication it’s always be used as a as a health supplement but yeah it was quite exciting for us you know i want to take this challenge and see if there’s any evidence a convincing evidence from literature to suggest

That it can be useful well let’s talk about the evidence and then we can talk about mechanisms but first what did you find in your analysis we found that patients who are taking ascorbic acid they had about 33 percent less risk of having contrast induced acute kidney injury which is quite significant actually previously many meta-analysis have been done on other

Pharmacological agents most commonly on anniston cysteine and there has been equal split you know some suggesting there is benefit some suggesting there isn’t but with this one with a kind of analysis that we perform sophistical ii it gave us a lot of convincing evidence that it can be quite useful in clinical practice what’s the mechanism behind this well there

Are multiple mechanisms which we think it involves you know before you can protect the kidney number one it is the occident it absorbs all those reactive oxygen species which we think are responsible for causing kidney damage secondly there is some evidence that it can also donate the blood vessels within the kidneys cord is causing medullary visit annotation you

Know middle row vasoconstriction is one of the mechanisms by which kidneys are damaged by contrast media so perhaps that’s another mechanism and thirdly we also know that patients who take ascorbic acid they do not have acidification of their urine in fact what we found was that the urine ph was increasing ie there was some aren ization of the urine now making the

Urine alkaline is itself a protective mechanism so that’s something which is very very surprising from the literature that that mechanism can also be a healthful way to break the kidneys against a contrast media because it’s ascorbic acid that is a surprise the surprise i mean it should be identifying the urine but there have been a few reports which suggest the

Ph is increasing which just goes against anyone’s expectations wow so where are we what needs to be done next well we have to understand you know what precisely is protecting the kidneys when you take ascorbic acid all the pathways which are involved in this after taking ascorbic is that we need to identify all of them and of course then it will be up to us you

Know whether we give it orally or whether intravenous administration and also by the dosage because that’s also something which has not been decided yet are you using it at all yeah we have done a few studies in cambridge we do suggest that ascorbic acid can be helpful but they have not been properly powered you know into a large trial they’re all pilot studies

And they have shown convincing evidence that ascorbic acid can be useful in patients off note is the point that those patients all did not have a pre-existing renal insufficiency so once we start once we start using them in patients who have got pre-existing renal insufficiency that will be the key point you know or see if this is really useful or not for all the

Details you really do need to go look at the paper in jack it is in the december 10th of the journal of american college of cardiology and we’re talking about the nefer protective role of ascorbic acid for dr. sadat i’m rick mcguire cardio source world news

Transcribed from video
Ascorbic Acid and Contrast-induced Kidney Injury By CSWNews