Author + information
- Peter A. McCullough, MD, MPH∗ ()
- ↵∗Baylor Heart and Vascular Institute, Baylor University Medical Center, 621 North Hall Street, H030, Dallas, Texas 75226
We appreciate the comments from Drs. Hemilä and Rezaei concerning small randomized trials of short-term vitamin E for the prevention of contrast-induced acute kidney injury (CI-AKI). In the trial reported in 2016, the CI-AKI rates consisted of 10 of 149 patients (6.7%) and 21 of 149 patients (14.1%), which yielded a 52.4% risk reduction (1). For this trial to have adequate (80%) power to find this effect size or greater, it would have required 266 patients per group. Thus, vitamin E, much like the early trials of N-acetylcysteine (NAC), likely has shown benefit in smaller trials as a result of an alpha error or random chance, and is not a true treatment effect (2). As in the case with NAC, large trials should be performed to follow-up on these small studies to help guide the field forward (3). Our personal view is that any form of prophylactic therapy will probably have a powerful mechanism of action and be given for at least a week after exposure to cover the duration when iodinated contrast is in the peritubular space and causes tubular damage.
Please note: Dr. McCullough has reported that he has no relationships relevant to the contents of this paper to disclose.
- 2017 American College of Cardiology Foundation
- Rezaei Y.,
- Khademvatani K.,
- Rahimi B.,
- Khoshfetrat M.,
- Arjmand N.,
- Seyyed-Mohammadzad M.H.
- ACT Investigators