Intravenous N-acetylcysteine for preventing contrast-induced nephropathy: a randomised trial
Nieves Carbonell1, Marisa Blasco, Rafael Sanjuán
1Coronary Care Unit, Hospital Clínic Universitari, València, Spain.
Insights
N-acetylcysteine did not prevent contrast-induced nephropathy in patients with normal renal function undergoing coronary angiography. This study found no additional benefit of N-acetylcysteine beyond hydration with saline.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Inconsistent data exists on N-acetylcysteine's role in preventing contrast-induced nephropathy (CIN).
- Limited information is available regarding its efficacy in patients with normal baseline renal function undergoing coronary angiography.
Purpose of the Study:
- To evaluate the effectiveness of intravenous N-acetylcysteine as an adjunct to hydration for preventing CIN.
- To assess the benefits in patients with normal renal function undergoing coronary angiography.
Main Methods:
- A prospective, double-blind, placebo-controlled trial was conducted.
- Patients received either N-acetylcysteine (600 mg twice daily) or placebo, plus intravenous saline.
- CIN was defined as a serum creatinine increase of ≥0.5 mg/dl or ≥25% from baseline at 48 hours post-contrast.
Main Results:
- The overall incidence of CIN was similar between groups (10.3% N-acetylcysteine vs. 10.1% placebo).
- No significant differences were observed in non-diabetic patients, though a trend for protection was noted in hypertensive diabetics.
- Adverse events were low, with no significant differences in hospital stay or mortality between groups.
Conclusions:
- Intravenous N-acetylcysteine offers no additional benefit over saline hydration for CIN prevention in high-risk coronary patients with normal renal function.
- Prophylactic N-acetylcysteine is not recommended in this specific patient population.
Background:
Studies evaluating the role of N-acetylcysteine in patients undergoing coronary angiography have yielded inconsistent data. Less is known about patients with normal renal function at baseline.
Methods:
Prospective, double-blind, placebo-controlled trial to determine the benefits of intravenous N-acetylcysteine as an adjunct to hydration in this kind of population. Patients were randomly assigned to receive either N-acetylcysteine (600 mg twice daily) or placebo, in addition to 0.45% intravenous saline. The primary end point was development of contrast-induced nephropathy, defined as an acute increase in the serum creatinine concentration > or = 0.5 mg/dl and/or > 25% increase above baseline level at 48 h after contrast dosing.
Results:
A total of 216 patients were studied: N-acetylcysteine = 107 and placebo = 109. Treatment groups were similar with respect to baseline clinical characteristics. Overall incidence of contrast-induced nephropathy was 10.2%, 10.3% in the N-acetylcysteine group and 10.1% in the placebo group. Furthermore, no significant differences were observed when considering the non-diabetic population, although there was a trend towards a protective effect of N-acetylcysteine in the subgroup of 47 patients with both hypertension and diabetes. There were no significant changes in serum urea nitrogen concentrations. The incidence of in-hospital adverse clinical events was low: no patient with contrast-induced nephropathy required dialysis, the median Coronary Unit stay was 4.5 vs. 4 days, and the mortality rate was 2.8% vs. 4.6% in the N-acetylcysteine and placebo groups, respectively (p=NS).
Conclusions:
The prophylactic administration of intravenous N-acetylcysteine provides no additional benefit to saline hydration in high-risk coronary patients with normal renal function.
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