Curcuminoids can prevent contrastinduced acute kidney injury in chronic kidney disease patients undergoing elective coronary procedures: A randomized controlled trial

Background: Contrast‐induced acute kidney injury (CI‐AKI) following coronary procedure is a common cause of renal impairment in hospitalized patients with an increasing incidence in chronic kidney disease (CKD) patients. Saline replacement and avoidance of nephrotoxic agents has been the standard prophylaxis for CI‐AKI. Additional anti‐oxidant supplements for prophylaxis CI‐AKI still controversial. Curcuminoids, the major extract compound from Curcuma longa that has many studies show evidence of antiinflammatory, anti‐oxidation activity, and possible protective effect of renal hemodynamics in the setting of acute kidney injury. In this randomized placebo‐controlled trial study we test curcuminoids to determine its effect on the prevention of CI‐AKI in CKD patients. Method: This study was done as a single‐centre, prospective, double‐blinded, randomized placebo‐controlled trial in CKD patients undergoing elective coronary angiography (CAG) at Vajira hospital from October 2018 to March 2019. Patients were stratified according to baseline estimate glomerular filtration rate (eGFR) and diabetes status. They were randomized to curcuminoids 1500 mg per day starting 3 days before and 2 days after coronary procedure or placebo. Each group also received standard protocol for prophylaxis CIAKI. The primary outcome was the development of CI‐AKI, defined as serum creatinine rising =0.3 mg/dL within 48 hours after coronary angiography compared to baseline serum creatinine and exclude other causes of AKI. The secondary outcomes were overall AKI within 7 days after CAG, change in eGFR, change in IL‐6 and hs‐CRP, and other adverse events. Result: A total of 60 patients were enrolled, 30 patients were assigned to the curcuminoids group, and 30 patients in the control group. CI‐AKI was developed in 4 patients in the control group and none in curcuminoids group (13.33% vs 0%, P‐value 0.112). Overall AKI developed in 5 patients in control group and none in curcuminoids group (16.67% vs 0%, P‐value 0.052). Changes in eGFR from baseline were more in control group (‐1.5 vs 2.5 mL/min/1.73 m2, P‐value <0.001 within 48 hours and‐4 vs 1 mL/min/1.73 m2, P‐value 0.002 within 7 days). However, no difference in changes of IL‐6 and hs‐CRP were noted between curcuminoids and control groups. In curcuminoids group, 3 patients had developed mild nausea and diarrhea, improved with supportive care. No serious adverse events as found in both groups. Conclusion: Prophylaxis administration with oral curcuminoids additional to standard treatment improved decreased in eGFR and possible reduce the incidence of CI‐AKI in CKD patients undergoing elective CAG. Further research is needed.