Efficacy of Ascorbic Acid on Reducing the Development of Contrast-Induced Nephropathy


1 Anesthesiologist, Department of Anesthesiology and Critical Care, Mashhad, IR Iran

2 Associate Professor of Anesthesiology and Critical Care, Cardiac Anesthesia Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran


Introduction: To assess the benefits of prophylactic ascorbic acid to reduce development of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary interventions (PCIs).
Methods: PubMed was searched with the search strategy of (vitamin C OR ascorbic acid) AND (kidney OR renal) AND (PCI OR percutaneous coronary Intervention OR cardiac OR heart). There was no date and language restriction for the selection of the articles.
All the randomized controlled trials (RCTs) which investigated the efficacy of AA on reducing the incidence of CIN were included. Totally 267 articles were found at the initial search; however, only 10 RCTs were eligible to be included. Odds ratio is presented for each of the articles as the effect size.
Conclusions: Controversial findings were reported on the efficacy of AA on reducing the CIN development; due to various limitations of these articles, there is still great debate among the cardiology and radiology communities, which increases the need for further researches.


  1. 1.ferences 1. Bagshaw SM, Culleton BF. Contrast-induced nephropathy: epidemiology and prevention. Minerva Cardioangiol. 2006;54(1):109–29. [PubMed: 16467746].

    1. Mittalhenkle A, Stehman-Breen CO, Shlipak MG, Fried LF, Katz R, Young BA, et al. Cardiovascular risk factors and incident acute renal failure in older adults: the cardiovascular health study. Clin J Am Soc Nephrol. 2008;3(2):450–6. doi: 10.2215/CJN.02610607. [PubMed: 18256380].
    2. Brezis M, Rosen S. Hypoxia of the renal medulla–its implications for disease. N Engl J Med. 1995;332(10):647–55. doi: 10.1056/NEJM199503093321006. [PubMed: 7845430].
    3. Mueller C, Buerkle G, Buettner HJ, Petersen J, Perruchoud AP, Eriksson U, et al. Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med. 2002;162(3):329–36. [PubMed: 11822926].
    4. Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med. 2000;343(3):180–4. doi: 10.1056/NEJM200007203430304. [PubMed: 10900277].
    5. Lloberas N, Torras J, Herrero-Fresneda I, Cruzado JM, Riera M, Hurtado I, et al. Postischemic renal oxidative stress induces inflammatory response through PAF and oxidized phospholipids. Prevention by antioxidant treatment. FASEB J. 2002;16(8):908–10. doi: 10.1096/fj.01- 0880fje. [PubMed: 12039876].
    6. Durak I, Ozbek H, Karaayvaz M, Ozturk HS. Cisplatin induces acute renal failure by impairing antioxidant system in guinea pigs: effects of antioxidant supplementation on the cisplatin nephrotoxicity. Drug Chem Toxicol. 2002;25(1):1–8. doi: 10.1081/DCT-100108468. [PubMed: 11850966].
    7. Sai K, Umemura T, Takagi A, Hasegawa R, Kurokawa Y. The protective role of glutathione, cysteine and vitamin C against oxidative DNA damage induced in rat kidney by potassium bromate. Jpn J Cancer Res. 1992;83(1):45–51. [PubMed: 1544873].
    8. Khaledifar A, Momeni A, Ebrahimi A, Kheiri S, Mokhtari A. Comparison of N-acetylcysteine, ascorbic acid, and normal saline effect in prevention of contrast-induced nephropathy. ARYA Atheroscler. 2015;11(4):228–32. [PubMed: 26478730].
    9. Spargias K, Alexopoulos E, Kyrzopoulos S, Iokovis P, Greenwood DC, Manginas A, et al. Ascorbic acid prevents contrast-mediated nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. Circulation. 2004;110(18):2837–42. doi: 10.1161/01.CIR.0000146396.19081.73. [PubMed: 15492300].
    10. Boscheri A, Weinbrenner C, Botzek B, Reynen K, Kuhlisch E, Strasser RH. Failure of ascorbic acid to prevent contrast-media induced nephropathy in patients with renal dysfunction. Clin Nephrol. 2007;68(5):279–86. [PubMed: 18044259].
    11. Briguori C, Airoldi F, D’Andrea D, Bonizzoni E, Morici N, Focaccio A, et al. Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL): a randomized comparison of 3 preventive strategies. Circulation. 2007;115(10):1211–7. doi: 10.1161/CIRCULATIONAHA.106.687152. [PubMed: 17309916].
    12. Jo SH, Koo BK, Park JS, Kang HJ, Kim YJ, Kim HL, et al. N-acetylcysteine versus AScorbic acid for preventing contrast-Induced nephropathy in patients with renal insufficiency undergoing coronary angiography NASPI study-a prospective randomized controlled trial. Am Heart J. 2009;157(3):576–83. doi: 10.1016/j.ahj.2008.11.010. [PubMed: 19249432].
    13. Alexopoulos E, Spargias K, Kyrzopoulos S, Manginas A, Pavlides G, Voudris V, et al. Contrast-induced acute kidney injury in patients with renal dysfunction undergoing a coronary procedure and receiving non-ionic low-osmolar versus iso-osmolar contrast media. Am J Med Sci. 2010;339(1):25–30. doi: 10.1097/MAJ.0b013e3181c06e70. [PubMed: 19996728].
    14. Zhou L, Chen H. Prevention of contrast-induced nephropathy with ascorbic acid. Intern Med. 2012;51(6):531–5. [PubMed: 22449658].
    15. Dvorsak B, Kanic V, Ekart R, Bevc S, Hojs R. Ascorbic Acid for the prevention of contrast-induced nephropathy after coronary angiography in patients with chronic renal impairment: a randomized controlled trial. Ther Apher Dial. 2013;17(4):384–90. doi: 10.1111/1744-9987.12083. [PubMed: 23931876].
    16. Albabtain MA, Almasood A, Alshurafah H, Alamri H, Tamim H. Efficacy of ascorbic acid, N-acetylcysteine, or combination of both on top of saline hydration versus saline hydration alone on prevention of contrast-Induced nephropathy: a prospective randomized study. J Interv Cardiol. 2013;26(1):90–6. doi: 10.1111/j.1540-8183.2012.00767.x. [PubMed: 22994682].
    17. Brueck M, Cengiz H, Hoeltgen R, Wieczorek M, Boedeker RH, Scheibelhut C, et al. Usefulness of N-acetylcysteine or ascorbic acid versus placebo to prevent contrast-induced acute kidney injury in patients undergoing elective cardiac catheterization: a single-center, prospective, randomized, double-blind, placebo-controlled trial. J Invasive Cardiol. 2013;25(6):276–83. [PubMed: 23735352].