title: Usefulness of N-acetylcysteine or ascorbic acid versus placebo to prevent contrast-induced acute kidney injury in patients undergoing elective cardiac catheterization: a single-center, prospective, randomized, double-blind, placebo-controlled trial.
abstract: BACKGROUND
  Contrast-induced acute kidney injury (CI-AKI) is a serious complication of procedures requiring contrast media associated with rising costs, prolonged hospitalization, and increased mortality. The aim of this study was to assess whether prophylactic administration of standard dosages of intravenous N-acetylcysteine or ascorbic acid reduce the incidence of CI-AKI in patients with chronic renal insufficiency undergoing elective cardiac catheterization.
  
  
  METHODS
  In a single-center, prospective, randomized, double-blind, placebo-controlled trial, the preventive effects of N-acetylcysteine and ascorbic acid were evaluated in 520 patients with chronically impaired renal function (serum creatinine ≥1.3 mg/dL) undergoing elective cardiac catheterization. The study drugs (600 mg N-acetylcysteine, 500 mg ascorbic acid, placebo) were administered intravenously twice (at 24 hours and 1 hour before the procedure). Serum creatinine, estimated glomerular filtration rate (eGFR) and serum urea were assessed at baseline and at 24 hours and 72 hours after contrast media exposure. CI-AKI was defined as a postangiographical increase in serum creatinine ≥0.5 mg/dL. Results. The incidence of CI-AKI was 27.6% in the N-acetylcysteine group (P=.20 vs placebo group) and in 24.5% in the ascorbic acid group (P=.11 vs placebo group). CI-AKI occurred in 32.1% of the placebo group.
  
  
  CONCLUSIONS
  Standard doses of N-acetylcysteine and ascorbic acid did not prevent CI-AKI in patients at high risk undergoing cardiac catheterization with non-ionic, low-osmolality contrast agent.
authors.affiliation: Department of Cardiology, Clinic of Wetzlar, Forsthausstrasse 1, 35578 Wetzlar, Germany. martin.brueck@lahn-dill-kliniken.de
authors.forename: Martin
authors.initials: M
authors.lastname: Brueck
authors.forename: Huelya
authors.initials: H
authors.lastname: Cengiz
authors.forename: Reinhard
authors.initials: R
authors.lastname: Hoeltgen
authors.forename: Marcus
authors.initials: M
authors.lastname: Wieczorek
authors.forename: Rolf-Hasso
authors.initials: RH
authors.lastname: Boedeker
authors.forename: Christine
authors.initials: C
authors.lastname: Scheibelhut
authors.forename: Andreas
authors.initials: A
authors.lastname: Boening
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control*; D061605:Administration, Intravenous; D000368:Aged; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006328:Cardiac Catheterization / Q000379:methods*; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D014508:Urea / Q000097:blood
chemical_list: D003287:Contrast Media; D014508:Urea; D003404:Creatinine; D001205:Ascorbic Acid; D000111:Acetylcysteine