A rapid protocol for the prevention of contrast-induced renal dysfunction: the RAPPID study.
OBJECTIVE
This study was designed to test a rapid protocol of intravenous acetylcysteine for prevention of radiocontrast-induced nephropathy (RCIN).


BACKGROUND
Oral acetylcysteine (NAC) may provide better prophylaxis against RCIN than intravenous (i.v.) hydration alone. Current protocols preclude prophylaxis of same-day or emergency patients owing to the need for prolonged pretreatment.


METHODS
We prospectively randomized 80 patients with stable renal dysfunction undergoing cardiac catheterization/intervention to a rapid protocol of i.v. NAC (150 mg/kg in 500 ml N/saline over 30 min immediately before contrast followed by 50 mg/kg in 500 ml N/saline over 4 h, n = 41, 67 +/- 10 years, 90% men) or i.v. hydration (1 ml/kg/h N/saline for 12 h pre- and post-contrast, n = 39, 71 +/- 8.8 years, 85% men).


RESULTS
Radiocontrast-induced nephropathy occurred in 2 of the 41 patients in the NAC group (5%) and in 8 of the 39 patients in the hydration group (21%; p = 0.045; relative risk: 0.28; 95% confidence interval 0.08 to 0.98). In the NAC group, mean serum creatinine fell from 1.85 +/- 0.59 to 1.77 +/- 0.73 and 1.79 +/- 0.73 mg/dl 48 h and four days post-contrast (p = 0.02 and 0.023 vs. baseline, respectively). In the hydration group, serum creatinine increased from 1.75 +/- 0.41 to 1.81 +/- 0.6 48 h and 1.80 +/- 0.50 mg/dl four days post-contrast (p = 0.99 and 0.23, respectively). NAC infusion was ceased after the bolus in three patients (7%) due to flushing, itching, or a transient rash.


CONCLUSIONS
Administration of i.v. NAC should be considered in all patients at risk of RCIN before contrast exposure when time constraints preclude adequate oral prophylaxis, provided the patient is able to tolerate this degree of volume loading.
Baker
Christopher S R
CS
Department of Cardiology, Charing Cross Hospital, Hammersmith Hospitals NHS Trust, London, United Kingdom. cbaker@hhnt.org
Wragg
Andrew
A
Kumar
Sanjay
S
De Palma
Rodney
R
Baker
Laurence R I
LR
Knight
Charles J
CJ
D000111:Acetylcysteine / Q000008:administration & dosage* / Q000627:therapeutic use*; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002985:Clinical Protocols; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015532:Rehydration Solutions / Q000008:administration & dosage* / Q000627:therapeutic use*; D051437:Renal Insufficiency / Q000097:blood / Q000139:chemically induced* / Q000517:prevention & control*; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000627:therapeutic use*; D013997:Time Factors; D014283:Triiodobenzoic Acids / Q000008:administration & dosage* / Q000009:adverse effects*
D003287:Contrast Media; D015532:Rehydration Solutions; D014283:Triiodobenzoic Acids; D012965:Sodium Chloride; D003404:Creatinine; C044834:iodixanol; D000111:Acetylcysteine