Prevention of contrast agent-induced renal impairment in patients with chronic renal insufficiency and heart disease by high-dose intravenous N-acetylcysteine: a pilot-ministudy.
BACKGROUND
Contrast-induced nephropathy is a relatively common complication occurring after various procedures requiring contrast agent injection, especially in patients with pre-existing renal failure.


OBJECTIVE
This pilot study was designed to assess the effects of a high intravenous dose of N-acetylcysteine (NAC) on plasma creatinine concentration.


METHODS
Twenty patients with pre-existing renal insufficiency were given NAC at a dose of 100 mg/kg. No contrast agent was given to 10 patients (Group A), whereas 10 patients received contrast at the time of coronary angiography (Group B). Changes in plasma creatinine were assessed at 3 hours and one day following NAC administration.


RESULTS
In Group B, NAC prevented creatinine increase: baseline levels were 210.98+/-77.33 micromol/L, 200.26+/-71.94 micromol/L (NS) after 3 hours, and 203.80+/-83.94 micromol/L 24 hours later (NS). The following was seen in Group A patients: 201.21+/-42.28 micromol/L, 190.31+/-42.74 micromol/L (p<0.01), and 170.08+/-45.53 micromol/L (p<0.01), respectively.


CONCLUSIONS
The results of this study confirm the effectiveness of NAC in prevention of contrast agent-induced renal impairment. In addition, we demonstrated the beneficial effects of NAC on renal function in patients who were not exposed to contrast agent. This pilot study should provide the basis for more comprehensive research and, also, for safe clinical practice.
Sochman
Jan
J
Department of Cardiology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 146 22, Prague 4, Czech Republic. jan.sochman@medicon.cz
Krizova
Barbora
B
D000111:Acetylcysteine / Q000008:administration & dosage*; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000517:prevention & control*; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D003404:Creatinine / Q000097:blood; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D007262:Infusions, Intravenous; D010865:Pilot Projects; D011044:Poland; D011292:Premedication; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012449:Safety; D016896:Treatment Outcome
D003287:Contrast Media; D003404:Creatinine; D000111:Acetylcysteine