Prehydration alone is sufficient to prevent contrast-induced nephropathy after day-only angiography procedures--a randomised controlled trial.
BACKGROUND
Contrast agents used in angiography procedures for patients with cardiovascular disease are known to cause contrast-induced nephropathy (CIN), which may be partially due to the production of nephrotoxic oxygen-free radicals. It is uncertain whether administration of intravenous (IV) anti-oxidant, N-acetylcysteine (NAC), can prevent reduction in renal function and whether this is a cost-effective approach.


METHODS
Sixty-five day-only patients with renal impairment (mean serum creatinine concentration 0.16+/-0.03 mmol/l) due to undergo coronary or peripheral angiography and/or stenting were randomly assigned to IV NAC 300 or 600 mg immediately before and after the procedure or IV fluid alone.


RESULTS
Of the 60 patients with complete data, none had acute CIN (increase in serum creatinine concentration > or = 0.044 mmol/l, 48 h after administration of contrast agent). Eight patients (13%) have demonstrated an increase in their serum creatinine concentration > or = 0.044 mmol/l 30 days after administration of contrast agent: 2/19 (11%) in the control group, 2/21 (10%) in the 600 mg NAC group and 4/20 (20%) the 300 mg NAC group (p = 0.66). The mean volumes of contrast agent used and prehydration given for each of the three groups did not differ significantly (p > 0.83). There was significant improvement in creatinine clearance within each group from baseline to 30 days (p < or = 0.03), but no significant difference between the groups at 48 h and 30 days (p > or = 0.43). Considering the cost of NAC and its administration, we estimate that this would translate to a saving of dollar 26,637 per annum.


CONCLUSIONS
For day-stay patients with mild-to-moderate chronic renal impairment undergoing angiography and/or intervention, prehydration alone is less complicated and more cost-effective than a combination of IV NAC (at doses used) and hydration.
Kotlyar
Eugene
E
Heart & Lung Transplant Unit, Cardiology Department, St. Vincent's Hospital, Xavier 4, Victoria St, Darlinghurst, NSW 2010, Australia. ekotlyar@stvincents.com.au
Keogh
Anne M
AM
Thavapalachandran
Sujitha
S
Allada
Christopher S
CS
Sharp
Jason
J
Dias
Leonora
L
Muller
David
D
D000111:Acetylcysteine / Q000008:administration & dosage* / Q000191:economics; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D005260:Female; D005440:Fluid Therapy; D016166:Free Radical Scavengers / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D007262:Infusions, Intravenous; D007472:Iohexol / Q000009:adverse effects / Q000031:analogs & derivatives*; D007674:Kidney Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000517:prevention & control*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged
D003287:Contrast Media; D016166:Free Radical Scavengers; D007472:Iohexol; C038192:iopromide; D000111:Acetylcysteine