Prevention of contrast-induced nephropathy with single bolus erythropoietin in patients with diabetic kidney disease: A randomized controlled trial

AimContrast-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. MethodsA 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 50000U 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. ResultsThe 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. ConclusionThe 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. Summary at a Glance Erythropoietin (EPO) has been shown to elicit tissue-protective effects in experimental models. This manuscript reports a prospective, randomized, controlled trial to evaluate the effectiveness of EPO in the prevention of contrast-induced nephropathy after coronary angiogram with or without percutaneous coronary intervention. This area of research is of significant interest to the readers of Nephrology.