title: Does intravenous or oral high-dose N-acetylcysteine in addition to saline prevent contrast-induced nephropathy assessed by cystatin C?
abstract: OBJECTIVE
  The objective of this study is to determine the effect of intravenous (i.v.) or oral N-acetylcysteine (NAC) in preventing contrast-induced nephropathy (CIN) in patients with moderate-to-severe renal insufficiency undergoing intra-arterial interventions.
  
  
  METHODS
  We studied 307 patients with estimated glomerular filtration rate of less than 60 ml/min/1.73 m undergoing an elective intra-arterial procedure. Patients were assigned randomly to three groups according to the prophylactic regimen used. In group 1, patients were administered an i.v. infusion of 0.9% saline (n=103); in group 2, patients were administered oral NAC in addition to an i.v. saline infusion (n=102); and in group 3, patients were administered i.v. NAC in addition to an i.v. saline infusion (n=102). Serum creatinine (SCr) and cystatin C levels were measured at baseline and 4, 24, and 48 h after the application of contrast media. The primary endpoint was defined as an increase in the SCr or cystatin C concentration of at least 0.5 mg/dl and/or of at least 25% from the baseline value at 48 h after administration of the contrast dye.
  
  
  RESULTS
  The overall incidence of SCr-based CIN was 11.1%: 6.8% in the saline group, 13.7% in the oral NAC group, and 12.7% in the i.v. NAC group (P=0.231). That of cystatin C-based CIN was 8.1%: 6.8% in the saline group, 6.9% in the oral NAC group, and 10.8% in the i.v. NAC group (P=0.491).
  
  
  CONCLUSIONS
  In this study, there was no detectable benefit of either high-dose oral or i.v. NAC over an aggressive hydration protocol in patients with moderate-to-severe renal insufficiency.
authors.affiliation: Departments of aCardiology bBiochemistry, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital cDepartment of Cardiology, Faculty of Medicine, Acibadem University, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Erturk
authors.forename: Nevzat
authors.initials: N
authors.lastname: Uslu
authors.forename: Sevket
authors.initials: S
authors.lastname: Gorgulu
authors.forename: Ertan
authors.initials: E
authors.lastname: Akbay
authors.forename: Gulsah
authors.initials: G
authors.lastname: Kurtulus
authors.forename: Ibrahim F
authors.initials: IF
authors.lastname: Akturk
authors.forename: Ozgur
authors.initials: O
authors.lastname: Akgul
authors.forename: Ozgur
authors.initials: O
authors.lastname: Surgit
authors.forename: Fatih
authors.initials: F
authors.lastname: Uzun
authors.forename: Mehmet
authors.initials: M
authors.lastname: Gul
authors.forename: Nilgun
authors.initials: N
authors.lastname: Isiksacan
authors.forename: Aydin
authors.initials: A
authors.lastname: Yildirim
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D000284:Administration, Oral; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000008:administration & dosage*; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D015642:Radiology, Interventional; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D012720:Severity of Illness Index; D016037:Single-Blind Method; D012965:Sodium Chloride / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D003287:Contrast Media; D055316:Cystatin C; D012965:Sodium Chloride; D003404:Creatinine; D000111:Acetylcysteine