title: N-acetylcysteine for the prevention of contrast-induced nephropathy in the emergency department.
abstract: OBJECTIVE
  To evaluate the use of N-acetylcysteine (NAC), a potent antioxidant, to prevent contrast-induced nephropathy (CIN).
  
  
  METHODS
  We prospectively studied 209 patients (106 in the NAC group and 103 in the control group) who received contrast-enhanced computed tomography (CECT) in the emergency department (ED). The NAC group received intravenous NAC (600 mg) before CECT imaging to prevent CIN. Both the NAC and control groups were treated using a standardized hydration strategy, where clinically feasible.
  
  
  RESULTS
  The patients' mean age was 79.6±9.8 years. The prevalence of hypertension, diabetes, and chronic kidney disease (CKD) were 63.2%, 27.3%, and 21.5%, respectively. The baseline clinical characteristics were similar between the two groups except for their body weight (p=0.011), amount of contrast material administered (p=0.049) and prevalence of CKD (p=0.002). The incidence of CIN was 7.5% in the NAC group and 14.6% in the control group. The adjusted odds ratio was 0.305 (95% confidence interval: 0.097 to 0.960, p=0.042). All-cause mortality was 7.5% in the NAC group and 12.6% in the control group, which was not significantly different. Temporary hemodialysis was required in 0% of subjects in the NAC group and 1.0% in the control group, which was not a statistically significant difference.
  
  
  CONCLUSIONS
  A single dose of NAC before CECT imaging can prevent CIN in an ED setting. However, it does not improve the mortality rate or the need for dialysis.
authors.affiliation: Department of Emergency Medicine, Taipei Veterans General Hospital, Taiwan.
authors.forename: Teh-Fu
authors.initials: TF
authors.lastname: Hsu
authors.forename: Ming-Kun
authors.initials: MK
authors.lastname: Huang
authors.forename: Shao-Hua
authors.initials: SH
authors.lastname: Yu
authors.forename: David Hung-Tsang
authors.initials: DH
authors.lastname: Yen
authors.forename: Wei-Fong
authors.initials: WF
authors.lastname: Kao
authors.forename: Ying-Chou
authors.initials: YC
authors.lastname: Chen
authors.forename: Mu-Shun
authors.initials: MS
authors.lastname: Huang
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects*; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007472:Iohexol / Q000009:adverse effects / Q000031:analogs & derivatives; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control* / Q000628:therapy; D008297:Male; D011446:Prospective Studies; D006435:Renal Dialysis; D013624:Taiwan; D014057:Tomography, X-Ray Computed / Q000009:adverse effects*
chemical_list: D003287:Contrast Media; C093233:iobitridol; D007472:Iohexol; C038192:iopromide; D000111:Acetylcysteine