Efficacy of N-acetylcysteine and hydration versus placebo and hydration in decreasing contrast-induced renal dysfunction in patients undergoing coronary angiography with or without concomitant percutaneous coronary intervention.
OBJECTIVE
Contrast-induced renal dysfunction is an iatrogenic complication that occurs more frequently in patients with preexisting renal dysfunction. A prospective, double-blind, randomized, placebo, controlled trial was completed to assess the efficacy of N-acetylcysteine in decreasing the incidence of contrast-induced renal dysfunction in patients with an acute coronary syndrome and renal insufficiency who underwent coronary angiography with or without percutaneous coronary intervention.


METHODS
With similar intravenous hydration protocols, 20 patients received N-acetylcysteine (treatment group) and 20 patients received placebo (control group) in a twice per day dosing regimen with one dose before and three doses after contrast media exposure.


RESULTS
The two groups were similar at baseline on demographic and clinical characteristics, and preexisting renal insufficiency. Contrast-induced renal dysfunction, defined as an increase in serum creatinine greater than 44 micromol/L (.5 mg/dL) and/or 25% above baseline within 48 hours, occurred in 7.5% of the cohort, with 2.5% in the treatment group, and 5% in the control group, for an absolute difference of 2.5%. There was no difference in serum creatinine or creatinine clearance at 24 hours or at 48 hours between the treatment and control groups.


CONCLUSIONS
These results suggest that this cohort gained no added protection to renal function with the use of N-acetylcysteine.
Seyon
Rajamalar A
RA
Department of Cardiology, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada.
Jensen
Louise A
LA
Ferguson
Ian A
IA
Williams
Randall G
RG
D000111:Acetylcysteine / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D005440:Fluid Therapy; D016166:Free Radical Scavengers / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D010919:Placebos; D012307:Risk Factors; D012965:Sodium Chloride / Q000008:administration & dosage
D003287:Contrast Media; D016166:Free Radical Scavengers; D010919:Placebos; D012965:Sodium Chloride; D000111:Acetylcysteine