Alpha-Lipoic Acid for the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography: The ALIVE Study - A Prospective Randomized Trial

Abstract

Objectives: α-Lipoic acid (ALA) is widely used for diabetic neuropathy due to its antioxidant properties. We evaluated its potential for preventing contrast-induced nephropathy (CIN). Methods: We conducted a prospective randomized controlled trial to evaluate the efficacy of ALA in CIN prevention. Two hundred and two patients with basal renal insufficiency who received elective coronary angiography were randomized to the ALA group [ALA treatment for 2 days (600 mg orally three times a day before and after coronary catheterization, n = 100)] or the control group (n = 102). The primary end point was the maximum increase in serum creatinine (sCr) and the secondary end point was the incidence of CIN defined as an increase in sCr of either ≥25% or ≥44.2 µmol/l. Results: Mean maximum increase in sCr was not different between the ALA and the control group (-1.32 ± 30.5 vs. -1.19 ± 30.1 µmol/l, respectively; p = 0.977). sCr did not significantly change from baseline (120.8 ± 69.8 vs. 122 ± 88.1 µmol/l) in the ALA group and the simple saline hydration group (108.2 ± 37.5 vs. 110 ± 49 µmol/l). There was a lower rate of CIN in the ALA group than in the control group, but the difference was not statistically significant (3.0 vs. 6.9%, respectively; p = 0.332). Conclusion: ALA showed no benefit in CIN prevention.

Pharmacological interventions for the prevention of contrast-induced acute kidney injury in high-risk adult patients undergoing coronary angiography: a systematic review and meta-analysis of randomised controlled trials

“…Forty-eight eligible RCTs15–62 enrolled 14 709 patients with CKD undergoing CAG±PCI. Figure 1 shows the results of the search and the number of citations at different stages of the selection process.…”

Novel Therapies for Acute Kidney Injury

“… 77 Another 2013 study measured the effect of ALA on the incidence of CIN in 200 patients with chronic renal disease (creatinine clearance <60 ml/min) and found no appreciable difference between the control and experimental groups. 8 However, patients aged older than 70 years and those in a predefined high-risk group who received a higher contrast load did experience a protective effect with ALA. ALA may also have some anti-inflammatory properties independent of its antioxidant properties. In patients who receive kidney-pancreas transplantations, when ALA was given to both the donor and recipient, markers of inflammation were diminished compared with the untreated group or the recipient-only treated group.…”

“… 7 Theophylline reduced risk of CIN Adenosine antagonists NCT01469624 in progress Evaluating effect of pentoxifylline on CIN Alpha-lipoic acid Jo et al. 8 Older patients (age >70 yr), higher contrast load, “high-risk group” had decreased incidence of AKI MENSA Ludwig et al. 9 Pretreatment with MESNA decreased risk of CIN Renal transplantation Alpha-lipoic acid Ambrosi et al.…”

Contrast-Induced Nephropathy: Management by Antioxidant Therapy

“…KMN'de ALA kullanımı ile ilgili 2 çalışma mevcuttur. ALIVE çalışmasında bazal olarak renal yetersizliği olan ve PKG ya-pılan 202 hastaya işlem öncesi ve sonrası bir gün 3 x 600 mg ALA verilmiştir (12) . ALA'nın KMN gelişimi üzerine koruyucu etkisi gösterilememiştir.…”