N-Acetylcysteine in nephrology; contrast nephropathy and beyond.
OBJECTIVE
Since the first publication appeared in 2000 showing that prophylactic oral administration of the antioxidant acetylcysteine, along with adequate hydration, can prevent the reduction in renal function induced by non-ionic, low-osmolality contrast agents, acetylcysteine has rapidly become widely used in clinical practice. Meanwhile, other applications of acetylcysteine in nephrology have been reported. This review analyses recent literature on the effects of acetylcysteine on radiocontrast-induced nephropathy, on plasma homocysteine concentrations, and on cardiovascular events in patients with end-stage renal failure.


RESULTS
At least 19 randomized trials evaluating acetylcysteine for the prevention of radiocontrast-induced nephropathy, at least five meta-analyses, and several reviews on that topic have been published within the past 4 years. The studies on radiocontrast-induced nephropathy showed remarkably mixed results, probably as a result of study heterogeneity. One study recently indicated that the administration of acetylcysteine during a haemodialysis session significantly lowered plasma homocysteine concentrations. Another study indicated that long-term antioxidative treatment with acetylcysteine significantly reduced cardiovascular events in patients with end-stage renal failure.


CONCLUSIONS
Although there are controversies on dosing and timing, the use of acetylcysteine together with hydration should be considered to protect patients from radiographic contrast media-induced nephropathy. Long-term antioxidative treatment with acetylcysteine in patients with end-stage renal failure may also be useful to prevent adverse cardiovascular events.
Med. Klinik IV, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, D-12200 Berlin, Germany. martin.tepel@charite.de
Martin
M
Tepel
Walter
W
Zidek
D000111:Acetylcysteine / Q000627:therapeutic use*; D000975:Antioxidants / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D003287:Contrast Media / Q000009:adverse effects*; D006710:Homocysteine / Q000097:blood; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000150:complications
D000975:Antioxidants; D003287:Contrast Media; D006710:Homocysteine; D000111:Acetylcysteine