N-Acetylcysteine versus fenoldopam mesylate to prevent contrast agent-associated nephrotoxicity.
OBJECTIVE
We performed a study to assess the efficacy of fenoldopam mesylate (a specific agonist of the dopamine-1 receptor) as compared with N-acetylcysteine (NAC) in preventing contrast agent-associated nephrotoxicity (CAN).


BACKGROUND
Prophylactic administration of NAC, along with hydration, prevents CAN in patients with chronic renal insufficiency who are undergoing contrast media administration. Preliminary data support the hypothesis that fenoldopam might be as effective as NAC.


METHODS
One hundred ninety-two consecutive patients with chronic renal insufficiency, referred to our institution for coronary and/or peripheral procedures, were assigned randomly to receive 0.45% saline intravenously and NAC (1,200 mg orally twice daily; NAC group; n = 97) or fenoldopam (0.10 microg/kg/min; fenoldopam group; n = 95) before and after a nonionic, iso-osmolality contrast dye administration.


RESULTS
Baseline creatinine levels were similar in the two groups: NAC group = 1.72 mg/dl (interquartile range, 1.55 to 1.90 mg/dl) and fenoldopam group = 1.75 mg/dl (interquartile range, 1.62 to 2.01 mg/dl) (p = 0.17). An increase of at least 0.5 mg/dl of the creatinine concentration 48 h after the procedure occurred in 4 of 97 patients (4.1%) in the NAC group and in 13 of 95 patients (13.7%) in the fenoldopam group (p = 0.019; odds ratio 0.27; 95% confidence interval 0.08 to 0.85). The amount of contrast media administration was similar in the two groups (NAC group = 160 +/- 82 ml; fenoldopam group = 168 +/- 104 ml; p = 0.54).


CONCLUSIONS
N-acetylcysteine seems to be more effective than fenoldopam in preventing CAN.
Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy. briguori.carlo@hsr.it
Carlo
C
Briguori
Antonio
A
Colombo
Flavio
F
Airoldi
Anna
A
Violante
Alfredo
A
Castelli
Pasquale
P
Balestrieri
Pietro
P
Paolo Elia
Bruno
B
Golia
Stefano
S
Lepore
Guido
G
Riviezzo
Pierfranco
P
Scarpato
Mariateresa
M
Librera
Amelia
A
Focaccio
Bruno
B
Ricciardelli
D000111:Acetylcysteine / Q000008:administration & dosage*; D000284:Administration, Oral; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D003404:Creatinine / Q000097:blood; D018491:Dopamine Agonists / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D018818:Fenoldopam / Q000008:administration & dosage*; D016166:Free Radical Scavengers / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control*; D008297:Male
D003287:Contrast Media; D018491:Dopamine Agonists; D016166:Free Radical Scavengers; D003404:Creatinine; D018818:Fenoldopam; D000111:Acetylcysteine