Prospective randomized study of N-acetylcysteine, fenoldopam, and saline for prevention of radiocontrast-induced nephropathy.
The objective of this study was to compare the efficacy of N-acetylcysteine (NAC), fenoldopam, and saline in preventing radiocontrast-induced nephropathy (RCIN) in high-risk patients undergoing cardiovascular procedures. We prospectively enrolled 123 patients who were scheduled for cardiovascular procedures and had a baseline creatinine > 1.6 mg/dl or creatinine clearance of < 60 ml/min. Patients were randomly assigned to receive either saline (0.45% normal saline at 1 cc/kg) for 12 hr before and 12 hr after the procedure, or fenoldopam (0.1 microg/kg/min) plus saline for 4 hr prior and 4 hr after the procedure, or NAC orally (600 mg) plus saline every 12 hr for 24 hr prior and 24 hr after the procedure. All the patients received low-osmolality nonionic contrast. RCIN was defined as an increase in creatinine level > 0.5 mg/dl after 48 hr. The incidence of RCIN was 17.7% in the NAC group, 15.3% in the saline group, and 15.7% in the fenoldopam group (P = 0.919). Of the 20 patients who developed RCIN, 2 required dialysis. Serum creatinine decreased after 48 hr (vs. baseline) in 38% patients in the NAC group, 18% in the fenoldopam group, and 15% in the saline group. In patients with chronic renal insufficiency, NAC or fenoldopam offered no additional benefit over hydration with saline in preventing RCIN.
Allaqaband
Suhail
S
Department of Cardiology, University of Wisconsin Medical School, Milwaukee Clinical Campus, Aurora-Sinai Medical Center, Milwaukee, Wisconsin 53201, USA. sallaqab@facstaff.wisc.edu
Tumuluri
Ramagopal
R
Malik
Ahmed M
AM
Gupta
Anjan
A
Volkert
Paul
P
Shalev
Yoseph
Y
Bajwa
Tanvir K
TK
D000111:Acetylcysteine / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography; D003404:Creatinine / Q000097:blood; D005260:Female; D018818:Fenoldopam / Q000627:therapeutic use*; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors; D012965:Sodium Chloride / Q000627:therapeutic use*; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D003287:Contrast Media; D016166:Free Radical Scavengers; D019275:Radiopharmaceuticals; D012965:Sodium Chloride; D003404:Creatinine; D018818:Fenoldopam; D000111:Acetylcysteine