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Acetylcysteine and contrast agent-associated nephrotoxicity
Carlo Briguori1, Fiore Manganelli, Pierfranco Scarpato
1Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Via Orazio 2, I-80121 Naples, Italy. cabrig@hotmail.com
Insights
Prophylactic acetylcysteine with hydration may help prevent contrast-induced kidney injury, especially with low contrast doses. However, the total contrast amount was the main predictor of nephrotoxicity in this study.
Area of Science:
- Nephrology
- Radiology
- Pharmacology
Background:
- Contrast media administration can precipitate acute kidney injury (AKI), sometimes necessitating dialysis.
- Patients with pre-existing renal impairment are at higher risk for contrast-induced nephropathy (CIN).
Purpose of the Study:
- To evaluate the efficacy of prophylactic acetylcysteine (N-acetylcysteine) combined with hydration versus hydration alone in preventing CIN.
- To identify predictors of CIN in patients undergoing angiography.
Main Methods:
- A randomized controlled trial involving 183 patients with renal impairment undergoing angiography.
- Patients received either intravenous saline with oral acetylcysteine or intravenous saline alone before and after contrast dye administration.
- Renal function was assessed by serum creatinine levels 48 hours post-procedure.
Main Results:
- No significant difference in overall CIN rates between the acetylcysteine and control groups (6.5% vs. 11%).
- However, in the subgroup receiving a low contrast dose (<140 ml), acetylcysteine significantly reduced CIN (0% vs. 8.5%, p=0.02).
- Multivariate analysis identified the volume of contrast agent, not acetylcysteine, as a significant predictor of CIN (OR 2.58).
Conclusions:
- Prophylactic acetylcysteine did not significantly reduce overall CIN rates in patients with renal impairment.
- The amount of contrast agent administered was the primary predictor of contrast-induced nephrotoxicity.
- Acetylcysteine may offer a protective benefit in patients receiving low contrast volumes.
Objectives:
Prophylactic acetylcysteine along with hydration seems to be better than hydration alone in preventing the reduction in renal function induced by a contrast dye.
Background:
Contrast media can lead to acute renal failure that may occasionally require hemodialysis.
Methods:
One hundred eighty-three consecutive patients with impairment of renal function, undergoing coronary and/or peripheral angiography and/or angioplasty, were randomly assigned to receive 0.45% saline intravenously and acetylcysteine (600 mg orally twice daily; group A, n = 92) or 0.45% saline intravenously alone (group B, n = 91) before and after nonionic, low-osmolality contrast dye administration.
Results:
The baseline serum creatinine concentrations were similar (1.5 +/- 0.4 mg/dl in group A vs. 1.5 +/- 0.4 mg/dl in group B; p = 0.37). An increase of > or =25% in the baseline creatinine level 48 h after the procedure occurred in 6 (6.5%) of 92 patients in group A and in 10 (11%) of 91 patients in group B (p = 0.22). In the subgroup with a low (<140 ml) contrast dose, renal function deterioration occurred in 5 (8.5%) of 60 patients in group B and in 0 of 60 patients in group A (p = 0.02; odds ratio [OR] 0.44, 95% confidence interval [CI] 0.35 to 0.54). In the subgroup with a high contrast dose, no difference was found (5/31 vs. 6/32 patients, p = 0.78). By multivariate analysis, the amount of contrast agent, but not the treatment strategy, was a predictor of the occurrence of contrast dye-associated nephrotoxicity (OR 2.58, 95% CI 1.1 to 4.9; p = 0.035).
Conclusions:
In patients with reduced renal function undergoing angiography and/or angioplasty, the amount of contrast agent, but not the administration of prophylactic acetylcysteine, was a predictor of renal function deterioration. Prophylactic acetylcysteine might provide better protection than hydration alone, only when a small volume of contrast agent is used.