A randomized controlled trial of N-acetylcysteine to prevent contrast nephropathy in cardiac angiography.
BACKGROUND
Contrast nephropathy (CN) is a common cause of renal dysfunction after cardiac angiography. Recently, N-acetylcysteine (NAC) has been found to reduce the risk of CN after CT imaging with contrast enhancement. The purpose of the current study was to evaluate the efficacy of NAC for the prevention of CN in the setting of cardiac angiography.


METHODS
Eligible patients were those undergoing cardiac angiography with serum creatinine>1.7 mg/dL. Patients were randomized to one of two groups: Group 1, IV hydration and NAC, 1200 mg one hour before angiography, and a second dose 3 hours after; Group 2, IV hydration and placebo. CN was defined as an increase of 0.5 mg/dL in serum creatinine.


RESULTS
Seventy-nine patients completed the study. There were no significant differences between the groups in baseline characteristics, duration of angiography, mean volume of dye infused or mean IV hydration. Contrast nephropathy developed in 24.0% of subjects, 26.3% NAC, and 22.0% placebo (P = NS). Among subjects with diabetes mellitus, there was no significant difference in the rate of CN between the groups (42.1% NAC, 27.8% placebo; P = 0.09). The independent predictors of CN risk were diabetes mellitus and preexisting chronic renal insufficiency.


CONCLUSIONS
NAC was not effective for the prevention of CN after cardiac angiography.
Durham
John D
JD
Division of Nephrology, Department of Pharmacy, and Division of Cardiology, Winthrop-University Hospital, Mineola, New York, USA.
Caputo
Christopher
C
Dokko
John
J
Zaharakis
Thomas
T
Pahlavan
Mohsen
M
Keltz
Jan
J
Dutka
Paula
P
Marzo
Kevin
K
Maesaka
John K
JK
Fishbane
Steven
S
D000111:Acetylcysteine / Q000494:pharmacology*; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D016166:Free Radical Scavengers / Q000494:pharmacology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D003287:Contrast Media; D016166:Free Radical Scavengers; D000111:Acetylcysteine