Prevention Of Contrast-induced Nephropathy With Ascorbic Acid:A Meta-analysis

Objective:The study sought to conduct a systematic review to discuss the prevention of contrast-induced nephropathy(CIN)with ascorbic acid in high risk patients,and to provide the evidence-based basis for the optimal use of ascorbic acid.Methods:The database PubMed,EMBASE,the Cochrane Library and CNKI were selected to search for the randomized controlled trails(RCTs)about which ascorbic acid reduces the incidence of CIN.The Cochrane handbook was used to assess the quality of the literature.Statistical analysis was performed with related extractive data by using statistical software stata version 12.0.Results:Nine randomized,controlled trials possessing the incidence of CIN including 1,408 patients were final identified for inclusion in the meta-analysis,in which there were 661 patients in the ascorbic acid group and 747 in the control group.All patients contained in the study were either the people with renal dysfunction or diabetes.The heterogeneity of these studies was small,so the fixed effect model was selected.Meta-Analysis results showed that in patients with high risk of chronic renal insufficiency or diabetes,compared with control group,the ascorbic acid can effectively reduce the incidence of CIN(RR = 0.548 [95% CI: 0445-0.766],P < 0.001).Compared with the control group,the average serum creatinine decreased 0.118mg/dl in ascorbicacid group,however,the results were not statistically significant([95%CI:-0.259-0.024],P=0.104).Neither ascorbic acid group nor control group received renal replacement therapy in the study.Conclusion:Ascorbic acid can effectively prevent the occurrence of CIN in patients with high-risk such as renal insufficiency or diabetes,and can be used as an effective prophylactic regimen.Ascorbic acid can reduce the increase of serum creatinine after using contrast agent,but it is not statistically significant compared with the control group.Because of the deficiency within the research design and the difference of the content,it is still required to conduct the multi-center,large-scale and high-quality randomized controlled trails to demonstrate the results.