Does N-acetylcysteine prevent contrast-induced nephropathy during endovascular AAA repair? A randomized controlled pilot study.
OBJECTIVE
To examine if N-acetylcysteine (NAC) reduces the incidence of contrast nephropathy during endovascular abdominal aortic aneurysm repair (EVAR) as evidenced by changes in markers of renal function.


METHODS
Twenty consecutive men (mean age 72 years, range 65-79) undergoing EVAR were randomized to receive standard intravenous fluid hydration or standard fluid hydration and NAC (600 mg BID orally, 4 doses). Venous blood and urine were collected prior to the procedure and for 5 postoperative days and analyzed blindly for serum creatinine, urinary retinol-binding protein (RBP), and albumin/creatinine ratio (ACR).


RESULTS
There were no significant differences in baseline demographics between the groups. No patient developed acute renal failure. In both groups, urinary RBP rose significantly from baseline (median 15 microg/mmol to peak 699 microg/mmol in controls versus 17 to 648 microg/mmol in the treatment group, p<0.003). There were similar significant rises in ACR (p<0.02). There was, however, no significant difference in the postoperative RBP or ACR between the groups at any time point.


CONCLUSIONS
EVAR causes significant acute renal injury in most patients. This was not attenuated by N-acetylcysteine. The causes of renal injury are probably multifactorial, the long-term clinical significance of which is unclear.
Moore
Nicholas N
NN
Cambridge Vascular Unit, Addenbrooke's Hospital Foundation Trust, UK.
Lapsley
Marta
M
Norden
Anthony G
AG
Firth
John D
JD
Gaunt
Michael E
ME
Varty
Kevin
K
Boyle
Jonathan R
JR
D000111:Acetylcysteine / Q000627:therapeutic use*; D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000517:prevention & control* / Q000652:urine; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000601:surgery* / Q000652:urine; D015415:Biomarkers / Q000097:blood / Q000652:urine; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006801:Humans; D007431:Intraoperative Complications / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control / Q000652:urine; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D012107:Research Design; D012177:Retinol-Binding Proteins / Q000652:urine; D012709:Serum Albumin / Q000378:metabolism; D015607:Stents; D013997:Time Factors; D017211:Treatment Failure; D014656:Vascular Surgical Procedures / Q000295:instrumentation
D015415:Biomarkers; D003287:Contrast Media; D016166:Free Radical Scavengers; D012177:Retinol-Binding Proteins; D012709:Serum Albumin; D003404:Creatinine; D000111:Acetylcysteine