title: N-acetylcysteine does not prevent contrast nephropathy in patients with renal impairment undergoing emergency CT: a randomized study.
abstract: BACKGROUND
  Patients admitted to the emergency room with renal impairment and undergoing a contrast computed tomography (CT) are at high risk of developing contrast nephropathy as emergency precludes sufficient hydration prior to contrast use. The value of an ultra-high dose of intravenous N-acetylcysteine in this setting is unknown.
  
  
  METHODS
  From 2008 to 2010, we randomized 120 consecutive patients admitted to the emergency room with an estimated clearance lower than 60 ml/min/1.73 m2 by MDRD (mean GFR 42 ml/min/1.73 m2) to either placebo or 6000 mg N-acetylcysteine iv one hour before contrast CT in addition to iv saline. Serum cystatin C and creatinine were measured one hour prior to and at day 2, 4 and 10 after contrast injection. Nephrotoxicity was defined either as 25% or 44 μmol/l increase in serum creatinine or cystatin C levels compared to baseline values.
  
  
  RESULTS
  Contrast nephrotoxicity occurred in 22% of patients who received placebo (13/58) and 27% of patients who received N-acetylcysteine (14/52, p = 0.66). Ultra-high dose intravenous N-acetylcysteine did not alter creatinine or cystatin C levels. No secondary effects were noted within the 2 groups during follow-up.
  
  
  CONCLUSIONS
  An ultra-high dose of intravenous N-acetylcysteine is ineffective at preventing nephrotoxicity in patients with renal impairment undergoing emergency contrast CT.
  
  
  BACKGROUND
  The study was registered as Clinical trial (NCT01467154).
authors.forename: Pierre-Alexandre
authors.initials: PA
authors.lastname: Poletti
authors.forename: Alexandra
authors.initials: A
authors.lastname: Platon
authors.forename: Sophie
authors.initials: S
authors.lastname: De Seigneux
authors.forename: Elise
authors.initials: E
authors.lastname: Dupuis-Lozeron
authors.forename: François
authors.initials: F
authors.lastname: Sarasin
authors.forename: Christoph D
authors.initials: CD
authors.lastname: Becker
authors.forename: Thomas
authors.initials: T
authors.lastname: Perneger
authors.forename: Patrick
authors.initials: P
authors.lastname: Saudan
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Martin
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods*
chemical_list: D003287:Contrast Media; D000111:Acetylcysteine