Improved estimation of glomerular filtration rate by serum cystatin C in preventing contrast induced nephropathy by N-acetylcysteine or zinc--preliminary results.
BACKGROUND
Prevention of contrast media (CM) induced nephropathy (CIN) by prophylaxis (e.g. N-acetylcysteine; NAC) is controversially discussed. Up to now, assessment of kidney function has been based on measurements of serum creatinine, although this biomarker has several limitations. We investigated NAC and zinc (Zn) for the prevention of CIN by monitoring creatinine and cystatin C.


METHODS
In a prospective, placebo-controlled, double blind trial, patients with moderately impaired kidney function receiving low-osmolar, non-ionic CM were randomly assigned to an oral treatment for 2 days with 1.2 g/day of NAC (n = 19), for 1 day with 60 mg/day of Zn (n = 18) or placebo (n = 17). All patients received peri-procedurally 1 ml/kg/h of 0.45% saline for 24 h. At baseline, prior to exposure of CM, 2 and 6 days after CM, creatinine and cystatin C were measured.


RESULTS
There was no difference in the incidence of CIN, but a significant drop in creatinine (P < 0.05) was observed in all patients during volume expansion. Creatinine showed no increase after CM and it was normalized to the baseline values in all groups at the study end. In contrast, 2 days after CM there was a significant rise in cystatin C in the Zn (P = 0.012) and the placebo (P = 0.041) group, whereas NAC prevented this deterioration of kidney function.


CONCLUSIONS
Cystatin C seems to reflect CM-induced changes in kidney function better than creatinine. NAC and Zn have no effect in preventing CIN by the standard definition, but based on cystatin C we can confirm a preventive effect of NAC. It appears mandatory to assess kidney function by cystatin C in CIN intervention trials, because relying on creatinine can be misleading.
Kimmel
Martin
M
Martin Kimmel, Robert Bosch Hospital, Auerbachstr, 110, D-70376, Stuttgart, Germany. vm.kimmel@t-online.de
Butscheid
Moritz
M
Brenner
Stefanie
S
Kuhlmann
Ulrich
U
Klotz
Ulrich
U
Alscher
Dominik Mark
DM
D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use*; D000284:Administration, Oral; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging; D003404:Creatinine / Q000097:blood; D055316:Cystatin C; D015891:Cystatins / Q000097:blood*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D016166:Free Radical Scavengers / Q000008:administration & dosage / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007275:Injections, Intravenous; D007479:Iopamidol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D008297:Male; D011480:Protease Inhibitors; D051437:Renal Insufficiency / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D017967:Zinc Compounds / Q000008:administration & dosage / Q000627:therapeutic use*
C525030:CST3 protein, human; D003287:Contrast Media; D055316:Cystatin C; D015891:Cystatins; D016166:Free Radical Scavengers; D011480:Protease Inhibitors; D017967:Zinc Compounds; C057937:iomeprol; D003404:Creatinine; D007479:Iopamidol; D000111:Acetylcysteine