Abstract
Short-term dietary restriction (DR) may prevent organ damage from ischemic or toxic insults in animals, but clear evidence in humans is missing. While especially intraarterial administration of contrast media represents a cause of hospital-acquired acute kidney injury (AKI), targeted preventive strategies are not available. This trial investigated the feasibility and effectiveness of pre-interventional DR for preventing AKI in patients undergoing percutaneous coronary intervention (PCI). Patients were randomized to receive a formula diet containing 60% of daily energy requirement (DR group) or ad-libitum food during the 4-day-interval before PCI. Primary endpoint was change of serum creatinine 48 h after PCI (Δcreatinine). Further analyses included incidence of AKI and safety evaluation. Δcreatinine post PCI in the DR group vs. the control group did not show any difference (DR: 0.03(−0.15,0.14)mg/dL vs. control: 0.09(−0.03,0.22)mg/dL;p = 0.797). Subgroup analyses revealed a significant beneficial impact of DR in patients that received ≤100 ml of contrast agent (DR n = 26: Δcreatinine −0.03(−0.20,0.08)mg/dL vs. control n = 24: Δcreatinine 0.10(−0.08,0.24)mg/dL; p = 0.041) and in patients with ≤2 risk factors for AKI (DR: n = 27; Δcreatinine −0.01(−0.18,0.07)mg/dL vs. control n = 31: Δcreatinine 0.09(−0.03,0.16)mg/dl; p = 0.030). Although the primary endpoint was not met, the results of this trial suggest a beneficial impact of DR in low-to-moderate risk patients.
Highlights
Short-term dietary restriction (DR) may prevent organ damage from ischemic or toxic insults in animals, but clear evidence in humans is missing
Due to its functional and structural properties, the kidney is especially sensitive to ischemic as well as toxic attacks, two mechanisms that are central to the pathophysiology of contrast media-induced acute kidney injury (CI-AKI)
In a first proof-of-principle clinical trial we showed that a 40%-calorie restriction given over 7 days prior to major cardiac surgery – a procedure associated with a high rate of postoperative ischemic AKI – might attenuate impairment of kidney function mirrored by a significantly reduced increase of serum creatinine at 48 h after surgery.[21]
Summary
Short-term dietary restriction (DR) may prevent organ damage from ischemic or toxic insults in animals, but clear evidence in humans is missing. While especially intraarterial administration of contrast media represents a cause of hospital-acquired acute kidney injury (AKI), targeted preventive strategies are not available This trial investigated the feasibility and effectiveness of pre-interventional DR for preventing AKI in patients undergoing percutaneous coronary intervention (PCI). Short-term DR has been proven to be feasible and safe in living kidney donors.[20] Recently, in a first proof-of-principle clinical trial we showed that a 40%-calorie restriction given over 7 days prior to major cardiac surgery – a procedure associated with a high rate of postoperative ischemic AKI – might attenuate impairment of kidney function mirrored by a significantly reduced increase of serum creatinine at 48 h after surgery.[21] Here, we report the results of a prospective, single-center, randomized, controlled clinical trial that tested the hypothesis that a 4-day diet with a 40% reduction of calorie intake prevents CI-AKI in at-risk-patients undergoing PCI
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