Prevention of contrast-induced nephropathy in vascular surgery patients.
Presently, only hydration and N-acetylcysteine have been shown to be effective in decreasing the incidence of radiographic contrast-induced nephropathy. We investigated the role of N-acetylcysteine and various hydration protocols in vascular surgery patients undergoing angiography. A single-center, randomized, placebo-controlled trial was conducted in patients with stable, preexisting renal dysfunction undergoing elective, outpatient angiography. Patients were randomized to outpatient oral hydration and N-acetylcysteine, inpatient hydration plus N-acetylcysteine, or our standard therapy of inpatient intravenous hydration alone. Two of twenty-eight (7%) patients who received outpatient oral hydration and N-acetylcysteine developed contrast-induced nephropathy, while two of 25 (8%) who recieved inpatient hydration plus N-acetylcysteine developed contrast-induced nephropathy and two of 25 (8%) who received standard therapy of inpatient intravenous hydration alone developed contrast-induced nephropathy. There was no statistical difference in incidence of contrast-induced nephropathy between the groups. No statistically significant independent risk factors were identified among the patients who developed contrast-induced nephropathy. N-Acetylcysteine did not confer additional benefit to patients treated with inpatient intravenous hydration. Outpatient oral hydration plus N-acetylcysteine was as effective at preventing contrast-induced nephropathy as inpatient therapies and avoided costly hospital admission.
Lawlor
D Kirk
DK
Division of Vascular Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada. klawlor@uwo.ca
Moist
Louise
L
DeRose
Guy
G
Harris
Kenneth A
KA
Lovell
Marjorie B
MB
Kribs
Stewart W
SW
Elliot
James
J
Forbes
Thomas L
TL
D000111:Acetylcysteine / Q000627:therapeutic use; D000553:Ambulatory Care; D000783:Aneurysm / Q000000981:diagnostic imaging; D000792:Angiography; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D005440:Fluid Therapy; D005500:Follow-Up Studies; D016166:Free Radical Scavengers / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology; D008297:Male; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging; D010919:Placebos; D011446:Prospective Studies; D012307:Risk Factors; D014656:Vascular Surgical Procedures