title: Evaluation of N-acetylcysteine for the prevention of contrast-induced nephropathy.
abstract: BACKGROUND
  Contrast-induced nephropathy (CIN) remains a leading cause of acute renal failure in hospitalized patients. N-Acetylcysteine has been studied previously for the prevention of CIN, resulting in mixed findings.
  
  
  OBJECTIVE
  The objective of this study was to determine the impact of N-acetylcysteine on the development of CIN in order to guide its use at community, teaching hospitals.
  
  
  METHODS
  Patients admitted between January 1 and December 31, 2011, receiving intravenous radiocontrast dye were included if they were compliant with two or more of the following conditions: baseline serum creatinine >1.2 mg/dL or estimated creatinine clearance <50 mL/min, age ≥75 years, diabetes mellitus, heart failure, or hypertension. The primary outcome was the difference in the proportion of patients in each group (N-acetylcysteine or no N-acetylcysteine) who developed CIN, which was defined as a ≥0.5 mg/dL increase in serum creatinine or a ≥25% increase in serum creatinine within 12-96 hours post-exposure to contrast.
  
  
  RESULTS
  A total of 302 patients were included, 151 who received N-acetylcysteine and 151 who did not receive N-acetylcysteine. Patients who received N-acetylcysteine had significantly worse renal function at baseline than those who did not receive N-acetylcysteine (mean pre-contrast serum creatinine, 1.41 vs. 0.95 mg/dL, p<0.0001). A lower proportion of patients developing CIN was observed between those who received N-acetylcysteine and those who did not receive N-acetylcysteine (10.2% vs. 21.8%, p=0.0428).
  
  
  CONCLUSIONS
  The use of N-acetylcysteine was likely associated with a reduced incidence of CIN in patients at risk for CIN development. Based on these results, hospitals may benefit from the development of a protocol to guide the appropriate use of N-acetylcysteine.
authors.affiliation: St. Louis College of Pharmacy, Saint Louis, MO, USA; Sara.Richter@stlcop.edu.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Richter
authors.affiliation: St. Louis College of Pharmacy and Mercy Hospital St. Louis, Saint Louis, MO, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Crannage
keywords: acute kidney injury; community hospital; nephrotoxicity; prophylaxis; risk factors