title: The High Risk of Contrast-induced Nephropathy in Patients with Suspected Pulmonary Embolism Despite Three Different Prophylaxis: A Randomized Controlled Trial.
abstract: The objective was to compare the protective effects of N-acetylcysteine (NAC) plus normal saline (NS), sodium bicarbonate (NaHCO3) plus NS, and NS alone in the prevention of contrast-induced nephropathy (CIN) after computed tomography pulmonary angiography (CTPA) in emergency patients.
  
  
  
  This study was planned as a randomized, controlled clinical research. Patients undergoing contrast-enhanced CTPA on suspicion of pulmonary embolism (PE) in the emergency department and with at least one risk factor for development of CIN were included in one of three different prophylaxis groups. The groups received 3 mL/kg intravenous (IV) NAC+NS or NaHCO3+NS solution or NS alone 1 hour before CTPA and 1 mL/kg IV per hour for a minimum of 6 hours after CTPA. CIN was evaluated as the primary outcome and moderate or severe renal insufficiency and in-hospital mortality as secondary outcomes.
  
  
  
  A total of 257 patients were enrolled in the study. The total level of CIN development was 23.7% (61/257), the level of moderate and severe renal failure was 12.5% (32/257), and the in-hospital mortality rate was 12.8% (33/257). Rates of CIN development in the drug groups were 23.5% in the NAC group (20/85), 21.2% (18/85) in the NaHCO3group, and 26.4% in the NS group (23/87). Rates of development of moderate or severe renal insufficiency were 9.4% in the NAC group (8/85), 10.6% in the NaHCO3group (9/85), and 17.2% in the NS group (15/87). In-hospital mortality rates were 12.9% in the NAC group (11/85), 11.8% in the NaHCO3group (10/85), and 13.8% in the NS group (12/87). No difference was determined between the drug groups in terms of CIN, moderate or severe renal injury, or hospital mortality.
  
  
  
  Our results indicate that there is a high risk of CIN in patients with suspected PE despite three different types of prophylaxis being administered, and no statistically significant differences were observed among prophylactic NAC, NaHCO3, and NS in prevention of CIN following contrast-enhanced CTPA.
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey. suleymanturedi@hotmail.com.
authors.forename: Suleyman
authors.initials: S
authors.lastname: Turedi
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Erkan
authors.initials: E
authors.lastname: Erdem
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Yunus
authors.initials: Y
authors.lastname: Karaca
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Tatli
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Aynur
authors.initials: A
authors.lastname: Sahin
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Suha
authors.initials: S
authors.lastname: Turkmen
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Gunduz
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography / Q000379:methods*; D003404:Creatinine; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000517:prevention & control*; D012307:Risk Factors; D017693:Sodium Bicarbonate / Q000627:therapeutic use*; D012965:Sodium Chloride / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; D003404:Creatinine; D000111:Acetylcysteine