Acetylcysteine and non-ionic isosmolar contrast-induced nephropathy--a randomized controlled study.
BACKGROUND
Intravenous administration of saline and non-ionic isosmolar contrast media significantly reduces the incidence of contrast-induced nephropathy, one of the most common causes of acute renal failure. Results with oral N-acetylcysteine are conflicting. The aim of our study was to evaluate the prophylactic role of N-acetylcysteine in patients with stable chronic renal failure undergoing coronary and/or peripheral angiography and/or angioplasty.


METHODS
We randomized 200 elective, consecutive patients (mean age 74.9 +/- 7.3 years; 65% male, 25% diabetics) with basal creatinine clearance <or=55 ml/min to receive oral N-acetylcysteine (600 mg bid the day before and the day of the procedure plus saline i.v. 0.9% 1 ml/kg/h 12-24 h before and 24 h after the procedure, n = 99) or placebo and saline at the same time intervals, n = 101. The contrast medium was non-ionic isosmolar (Iodixanol, Visipaque Amersham Health). Contrast-induced nephropathy was defined as an increase in serum creatinine >0.5 mg/dl or >25% within 3 days after the procedure. Serum creatinine was measured at baseline, 24, 48 and 72 h after the procedure.


RESULTS
Contrast-induced nephropathy was 8/99 (8.1%) in the N-acetylcysteine group versus 6/101 (5.9%) in the placebo group, P = 0.6. No difference was noted in high-risk subgroups such as diabetics (4/25 versus 2/25 P = 0.4) and those with serum creatinine clearance <42.3 ml/min (5/54 versus 4/48; P = 0.9).


CONCLUSIONS
In our experience, N-acetylcysteine did not prevent contrast-induced nephropathy in patients receiving isosmolar (iodixanol) contrast media and adequate hydration.
Ferrario
Francesca
F
Nephrology and Dialysis Ospedale L. Sacco, Milano, Italy.
Barone
Maria Teresa
MT
Landoni
Giovanni
G
Genderini
Augusto
A
Heidemperger
Marco
M
Trezzi
Matteo
M
Piccaluga
Emanuela
E
Danna
Paolo
P
Scorza
Daniele
D
D000111:Acetylcysteine / Q000627:therapeutic use*; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D007676:Kidney Failure, Chronic; D008297:Male; D009994:Osmolar Concentration; D011446:Prospective Studies
D003287:Contrast Media; D016166:Free Radical Scavengers; D000111:Acetylcysteine