N-acetylcysteine for radiocontrast-induced nephropathy: potential role in the emergency department?
OBJECTIVE
To systematically review the efficacy and safety of N-acetylcysteine (NAC) for the prevention of radiocontrast-induced nephropathy (RIN), and to discuss its potential role in the emergency department.


METHODS
We conducted a search of MEDLINE (from 1966 to December 2003), PubMed (1966 to December 2003) and EMBASE (1988 to December 2003) for English-language, prospective, randomized, controlled trials in humans using the search terms N-acetylcysteine, acetylcysteine, radiopharmaceuticals, contrast media, and kidney failure (acute).


RESULTS
Five trials support and 4 trials refute the hypothesis that NAC helps prevent RIN. In 7 of 9 trials, oral NAC was administered twice daily for 2 days, on the day before and on the day of the radiocontrast study--a regime not feasible for emergent situations. More recent trials suggest that adequate hydration and lower volumes of radiocontrast, rather than NAC, are more effective ways to prevent RIN.


CONCLUSIONS
Although further study may be indicated, current evidence does not suggest that NAC has a role in the emergency prevention of RIN.
Chong
Elaine
E
Clinical Services, Virtual Learning Inc., Toronto, Ontario, Canada.
Zed
Peter J
PJ