Prevention of radiocontrast-induced nephropathy with N-acetylcysteine in patients undergoing coronary angiography.
OBJECTIVE
Acetylcysteine in patients undergoing computerized tomography with intravenous contrast reduces the incidence of acute renal dysfunction. We examined the effect of N-acetylcysteine in patients undergoing coronary angiography.


METHODS
Fifty-five consecutive patients receiving 3 doses of N-acetylcysteine prior to cardiac catheterization were compared to 55 historical controls. All patients in both groups had baseline serum creatinine > 1.2 mg/dl and received intravenous hydration before and after the procedure. Serum creatinine levels at baseline and 48 hours after the procedure were compared.


RESULTS
Univariate analysis of clinical variables revealed no significant differences between the groups except for a higher baseline creatinine in the treatment group (2.0   0.7 vs. 1.8   0.4 mg/dl; p = 0.04). There was no difference in the amount or type of contrast used. The mean change in creatinine after 48 hours was -0.4   0.3 versus +0.1   0.3 mg/dl for treatment and control groups (p < 0.001). In patients with baseline creatinine > 2 mg/dl, the benefit was larger (-0.4   0.4 vs. +0.5   0.3 mg/dl; p < 0.001). Multivariate analysis confirmed pre-treatment with N-acetylcysteine as an independent predictor of renal protection (p < 0.001).


CONCLUSIONS
Prophylactic use of acetylcysteine prevented reduction of renal function after coronary angiography. The benefit was greater in patients with baseline serum creatinine > 2 mg/dl.
Tadros
George M
GM
Department of Internal Medicine, Geisinger Medical Center, Danville, PA 17822, USA. gmtadros@geisinger.edu
Mouhayar
Elie N
EN
Akinwande
Akindolapo O
AO
Campbell
Brenda
B
Wood
Craig
C
Blankenship
James A
JA
D000111:Acetylcysteine / Q000008:administration & dosage*; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control*; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D003404:Creatinine / Q000652:urine; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000009:adverse effects*; D012016:Reference Values; D016896:Treatment Outcome
D003287:Contrast Media; D019275:Radiopharmaceuticals; D003404:Creatinine; D000111:Acetylcysteine