title: Effect of N-acetylcysteine on cystatin C-based renal function after elective coronary angiography (ENABLE Study): a prospective, randomized trial.
abstract: BACKGROUND
  Several studies have reported the role of N-acetylcysteine on the prevention of contrast induced nephropathy (CIN) with conflicting results. To date, the effect of acetylcysteine on cystatin C-based CIN has not been described. This study was designed to examine the incidence of cystatin C-based CIN and investigate the effect of N-acetylcysteine on the prevention of CIN after coronary angiography (CAG).
  
  
  METHODS
  We conducted a prospective, randomized trial on 166 patients (80 patients in N-acetylcysteine group and 86 patients in control group) that underwent elective CAG with apparently normal renal function. Serum cystatin C and creatinine concentrations were measured before, and at 24 and 48 h after CAG.
  
  
  RESULTS
  The overall incidence of cystatin C-based CIN among all study subjects was 10.2% (5.0% in N-acetylcysteine group and 15.1% in control group, p<0.05) and that of serum creatinine-based CIN was 6% (3.8% in N-acetylcysteine group and 8.1% in control group, p=NS). Kappa analysis between cystatin C-based CIN and serum creatinine-based CIN showed a substantial agreement (k=0.64). Multivariate logistic regression analysis showed that N-acetylcysteine administration was independently protective against the development of cystatin C-based CIN (Odd ratio[95% confidence interval] 0.255[0.066 to 0.994]) but there was a trend toward protection against that of serum creatinine-based CIN.
  
  
  CONCLUSIONS
  This study suggests that in patients with apparently normal renal function, prophylactic oral N-acetylcysteine administration is effective at preventing cystatin C-based CIN development after elective coronary angiography and/or intervention, and that serum cystatin C might be a more sensitive marker of the early CIN than serum creatinine.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-Dong, Jongro-Gu, Seoul, 110-746 Republic of Korea. bjjake.kim@samsung.com
authors.forename: Byung Jin
authors.initials: BJ
authors.lastname: Kim
authors.forename: Ki Chul
authors.initials: KC
authors.lastname: Sung
authors.forename: Bum Soo
authors.initials: BS
authors.lastname: Kim
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Kang
authors.forename: Kyu Beck
authors.initials: KB
authors.lastname: Lee
authors.forename: Hyang
authors.initials: H
authors.lastname: Kim
authors.forename: Man Ho
authors.initials: MH
authors.lastname: Lee
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D000284:Administration, Oral; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects* / Q000706:statistics & numerical data; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D005260:Female; D016166:Free Radical Scavengers / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012044:Regression Analysis
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D055316:Cystatin C; D016166:Free Radical Scavengers; D003404:Creatinine; D000111:Acetylcysteine