title: Efficacy of ascorbic acid, N-acetylcysteine, or combination of both on top of saline hydration versus saline hydration alone on prevention of contrast-Induced nephropathy: a prospective randomized study.
abstract: BACKGROUND
  Antioxidant drugs such as N-acetylcysteine (NAC) and ascorbic acid have been evaluated in interventional studies to prevent contrast-induced nephropathy (CIN), however, there are limited data on comparing either or both, with background of standard intravenous saline hydration versus the standard intravenous saline hydration alone in preventing CIN.
  
  
  METHODS
  We conducted a single-center randomized trial among patients undergoing coronary angiography or percutaneous coronary intervention who had serum creatinine ≥ 1.3 mg/dL or were on diabetes mellitus medication. Eligible patients were randomly assigned to one of the following 4 groups: (1) NAC, (2) ascorbic acid, (3) combination of both drugs, and (4) control group. Additionally, all the groups received the standard intravenous saline hydration. Creatinine was measured 4-5 days after procedure.
  
  
  RESULTS
  A total of 243 patients were randomized; 62 to NAC, 57 to ascorbic acid, 58 to both drugs, and 66 to placebo. The development of 0.5 mg/dL absolute increase of serum creatinine, 25% relative decrease of creatinine clearance, or either (CIN) were measured in the ascorbic acid group (3.6% for all), NAC group (6.8%, 3.4%, 8.5%, respectively), combined group (5.5%, 5.5%, 9.1%, respectively), and control group (6.2%, 6.2%, 7.7%, respectively). None of these differences were significant (P = 0.896 for serum creatinine, P = 0.863 for creatinine clearance, and P = 0.684 for CIN).
  
  
  CONCLUSIONS
  In a cohort of patients at risk of developing CIN, we could not detect any significant benefit of the use of ascorbic acid, NAC, or a combination of both drugs over the standard hydration regimen in preventing CIN.
authors.affiliation: Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
authors.forename: Monirah A
authors.initials: MA
authors.lastname: Albabtain
authors.forename: Ali
authors.initials: A
authors.lastname: Almasood
authors.forename: Hytham
authors.initials: H
authors.lastname: Alshurafah
authors.forename: Hussain
authors.initials: H
authors.lastname: Alamri
authors.forename: Hani
authors.initials: H
authors.lastname: Tamim
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000975:Antioxidants / Q000627:therapeutic use; D001205:Ascorbic Acid / Q000627:therapeutic use; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000032:analysis; D004359:Drug Therapy, Combination; D005260:Female; D005440:Fluid Therapy; D016166:Free Radical Scavengers / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000975:Antioxidants; D003287:Contrast Media; D016166:Free Radical Scavengers; D003404:Creatinine; D001205:Ascorbic Acid; D000111:Acetylcysteine