Prophylactic acetylcysteine usage for prevention of contrast nephropathy after coronary angiography

Area of Science:

• Nephrology
• Cardiology
• Radiology

Background:

• Radiographic contrast agents can induce acute kidney injury.
• Antioxidants like acetylcysteine are investigated for preventing contrast-induced nephropathy.
• Patients with pre-existing renal dysfunction are at higher risk.

Purpose of the Study:

• To evaluate the efficacy of oral acetylcysteine in preventing contrast nephropathy.
• To compare acetylcysteine plus hydration versus hydration alone in at-risk patients.
• To identify risk factors for contrast nephropathy in patients undergoing coronary angiography.

Main Methods:

• A randomized controlled trial involving 50 patients with serum creatinine > 1.3 mg/dL undergoing coronary angiography.
• One group received oral acetylcysteine (600 mg twice daily) plus hydration; the control group received hydration alone.
• Intravenous saline hydration was administered before and after contrast agent administration.

Main Results:

• Contrast nephropathy occurred in 12% of the acetylcysteine group and 8% of the control group (P > 0.05).
• Patients with baseline creatinine > 2.5 mg/dL had a significantly higher incidence of contrast nephropathy (50%) compared to those with creatinine < 2.5 mg/dL (6.5%) (P = 0.04).
• No significant difference in contrast nephropathy rates was observed between the acetylcysteine and control groups.

Conclusions:

• Oral acetylcysteine with hydration is not more effective than hydration alone for preventing contrast nephropathy in patients with renal dysfunction undergoing coronary angiography.
• Elevated baseline serum creatinine levels are a significant risk factor for contrast-induced nephropathy.