The role of N-acetylcysteine in the prevention of contrast-induced nephrotoxicity.
OBJECTIVE
To determine the role of prophylactic N-acetylcysteine in the prevention of contrast-induced nephrotoxicity.


METHODS
One hundred and sixteen patients undergoing noncoronary angiography, with or without pre-existing renal impairment, were randomly assigned to receive prophylactic oral N-acetylcysteine or no treatment. Serum creatinine (sCr) was measured prior to angiography and 48 hr after the procedure. Urine samples were collected before and after the examination for measurement of malondialdehyde (MDA) concentration. Contrast-induced nephrotoxicity (CIN) was defined as a rise in serum creatinine of 0.5 mg/dl (44 mmol/l) at 48 hr.


RESULTS
Complete data were available on 106 patients, 53 of whom had received N-acetylcysteine. There were no significant differences between the two groups in baseline characteristics, type of angiogram, or volume and concentration of contrast used. Three patients (2.8%), all of whom had received N-acetylcysteine, developed CIN. In the N-acetylcysteine group, the mean serum creatinine in patients with renal impairment was 151.0 +/- 44.2 micromol/l prior to the procedure and 155.6 +/- 48.6 micromol/l (p = 0.49) after the procedure. Respective values for those without renal impairment were 79.6 +/- 15.1 micromol/l and 81.2 +/- 20.0 micromol/l (p = 0.65). In the group that had not received N-acetylcysteine, the mean serum creatinine levels before and after the procedure were 150.0 +/- 58.1 and 141.4 +/- 48.0 micromol/l (p = 0.17) in patients with renal impairment and 79.7 +/- 14.2 and 81.4 +/- 15.4 micromol/l (p = 0.34) in those without renal impairment. In both groups, no significant change in urinary MDA concentration was observed.


CONCLUSIONS
There is no benefit to the prophylactic administration of N-acetylcysteine in patients undergoing peripheral angiography using current contrast media.
Sandhu
Caron
C
Department of Radiology, Guy's and St. Thomas's Hospital, London, UK. caron.sandhu@gstt.sthames.nhs.uk
Belli
Anna-Maria
AM
Oliveira
David B
DB
D000111:Acetylcysteine / Q000627:therapeutic use*; D000368:Aged; D000792:Angiography / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006801:Humans; D007479:Iopamidol / Q000009:adverse effects*; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D007677:Kidney Function Tests; D008297:Male; D008315:Malondialdehyde / Q000652:urine; D008875:Middle Aged; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids / Q000009:adverse effects*
D003287:Contrast Media; D016166:Free Radical Scavengers; D014283:Triiodobenzoic Acids; D008315:Malondialdehyde; D003404:Creatinine; C044834:iodixanol; D007479:Iopamidol; D000111:Acetylcysteine