Selenium for the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography and Percutaneous Interventions: A Double-Blinded Randomized Controlled Trial

Abstract

Background: Contrast-induced nephropathy (CIN) is a common cause of acute kidney injury and is associated with significant morbidity and mortality even if transient or successfully treated. The preventive measures currently available have failed to show significant efficacy. Selenium, which is involved in anti-oxidative reactions, might have protective effects against CIN. Methods: 237 patients undergoing coronary angiography or intervention were randomly assigned to receive placebo (n=120) or selenium (200 mcg daily on the pre-procedural day, procedural day, and the first post-procedural day) (n=117). Serum creatinine was measured before and two days after the procedure. The primary endpoint was the occurrence of CIN within forty-eight hours. Results: Baseline characteristics were not different between the groups. CIN occurred in 13 (11.1%) patients in the selenium group and in 23 (19.2%) in the placebo group (odds ratio (or) 95% confidence interval (CI): 1.72 (0.92-3.24), p value=0.084). Selenium intake was significantly associated with lower rates of CIN in the males (or (95% CI): 2.33 (1.10-5.48), p value=0.04), hypertensive patients (or (95% CI): 2.69 (1.12-7.53), p value=0.04), those with a left ventricular ejection fraction <50% (or (95% CI): 5.38 (1.26-22.9), p value=0.008), and those who underwent percutaneous coronary interventions (or (95% CI): 1.98 (1.01-3.99), p value=0.04). Conclusion: Selenium, as an antioxidant, might decrease the occurrence of CIN, especially in high-risk patients undergoing coronary angiography or percutaneous coronary intervention. Nevertheless, routine recommendation of selenium to these patients needs further investigations.