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Acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary
Kou Gi Shyu1, Jun Jack Cheng, Peiliang Kuan
1Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. shyukg@ms12.hinet.net
Insights
Acetylcysteine effectively prevents contrast-induced nephrotoxicity in patients with chronic kidney disease undergoing coronary procedures. This antioxidant treatment, combined with hydration, significantly reduces acute kidney damage, offering a protective strategy for vulnerable patients.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Contrast-induced nephrotoxicity (CIN) is a growing concern with increased use of contrast-enhanced imaging in coronary artery disease.
- Reactive oxygen species play a key role in the development of CIN.
Purpose of the Study:
- To evaluate the effectiveness of the antioxidant acetylcysteine in preventing kidney damage following coronary procedures.
- To assess the impact of acetylcysteine on contrast-induced nephrotoxicity in patients with pre-existing renal insufficiency.
Main Methods:
- A prospective study involving 121 patients with chronic renal insufficiency undergoing coronary procedures.
- Randomized assignment to receive either oral acetylcysteine (400 mg twice daily) plus intravenous saline or placebo plus saline.
- Monitoring of serum creatinine and blood urea nitrogen levels pre-procedure and at 48 hours and 7 days post-procedure.
Main Results:
- Only 3.3% of patients receiving acetylcysteine experienced a significant increase in serum creatinine compared to 24.6% in the control group (p < 0.001).
- Acetylcysteine treatment led to a significant decrease in mean serum creatinine levels at 48 hours post-procedure.
- The control group showed a significant increase in mean serum creatinine levels at 48 hours post-procedure.
Conclusions:
- Prophylactic oral acetylcysteine, combined with hydration, is effective in reducing acute kidney damage from contrast agents.
- This antioxidant strategy is beneficial for patients with chronic renal insufficiency undergoing coronary procedures.
Objectives:
We sought to evaluate the efficacy of the antioxidant acetylcysteine in limiting the nephrotoxicity after coronary procedures.
Background:
The increasingly frequent use of contrast-enhanced imaging for diagnosis or intervention in patients with coronary artery disease has generated concern about the avoidance of contrast-induced nephrotoxicity (CIN). Reactive oxygen species have been shown to cause CIN.
Methods:
We prospectively studied 121 patients with chronic renal insufficiency (mean [+/-SD] serum creatinine concentration 2.8 +/- 0.8 mg/dl) who underwent a coronary procedure. Patients were randomly assigned to receive either acetylcysteine (400 mg orally twice daily) and 0.45% saline intravenously, before and after injection of the contrast agent, or placebo and 0.45% saline. Serum creatinine and blood urea nitrogen were measured before, 48 h and 7 days after the coronary procedure.
Results:
Seventeen (14%) of the 121 patients had an increase in their serum creatinine concentration of at least 0.5 mg/dl at 48 h after administration of the contrast agent: 2 (3.3%) of the 60 patients in the acetylcysteine group and 15 (24.6%) of the 61 patients in the control group (p < 0.001). In the acetylcysteine group, the mean serum creatinine concentration decreased significantly from 2.8 +/- 0.8 to 2.5 +/- 1.0 mg/dl (p < 0.01) at 48 h after injection of the contrast medium, whereas in the control group, the mean serum creatinine concentration increased significantly from 2.8 +/- 0.8 to 3.1 +/- 1.0 mg/dl (p < 0.01).
Conclusions:
Prophylactic oral administration of the antioxidant acetylcysteine, along with hydration, reduces the acute renal damage induced by a contrast agent in patients with chronic renal insufficiency undergoing a coronary procedure.