Prevention of contrast-induced nephropathy in vascular surgery patients
D Kirk Lawlor1, Louise Moist, Guy DeRose
1Division of Vascular Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada. klawlor@uwo.ca
Insights
Outpatient oral hydration with N-acetylcysteine effectively prevents contrast-induced nephropathy in vascular surgery patients. This approach is as effective as inpatient therapies and avoids hospital admission.
Area of Science:
- Nephrology
- Cardiology
- Vascular Surgery
Background:
- Radiographic contrast media can induce kidney damage, known as contrast-induced nephropathy (CIN).
- Hydration and N-acetylcysteine are currently the primary interventions to reduce CIN incidence.
- Vascular surgery patients undergoing angiography are at risk for CIN, necessitating effective preventative strategies.
Purpose of the Study:
- To evaluate the efficacy of N-acetylcysteine combined with different hydration protocols in preventing CIN.
- To compare outpatient oral hydration with N-acetylcysteine against inpatient hydration strategies.
Main Methods:
- A single-center, randomized, placebo-controlled trial was conducted.
- Patients with pre-existing renal dysfunction undergoing elective outpatient angiography were enrolled.
- Three groups were compared: outpatient oral hydration plus N-acetylcysteine, inpatient hydration plus N-acetylcysteine, and standard inpatient intravenous hydration alone.
Main Results:
- The incidence of CIN was 7% in the outpatient oral hydration and N-acetylcysteine group.
- The incidence of CIN was 8% in the inpatient hydration plus N-acetylcysteine group.
- The incidence of CIN was 8% in the standard inpatient intravenous hydration group, with no statistical difference between groups. N-acetylcysteine provided no additional benefit to inpatient hydration.
Conclusions:
- Outpatient oral hydration with N-acetylcysteine is a viable and effective alternative to inpatient therapies for CIN prevention.
- This outpatient strategy is as effective as inpatient treatments and offers the advantage of avoiding hospital admission.
- No independent risk factors for CIN were identified in this patient cohort.
Abstract:
Presently, only hydration and N-acetylcysteine have been shown to be effective in decreasing the incidence of radiographic contrast-induced nephropathy. We investigated the role of N-acetylcysteine and various hydration protocols in vascular surgery patients undergoing angiography. A single-center, randomized, placebo-controlled trial was conducted in patients with stable, preexisting renal dysfunction undergoing elective, outpatient angiography. Patients were randomized to outpatient oral hydration and N-acetylcysteine, inpatient hydration plus N-acetylcysteine, or our standard therapy of inpatient intravenous hydration alone. Two of twenty-eight (7%) patients who received outpatient oral hydration and N-acetylcysteine developed contrast-induced nephropathy, while two of 25 (8%) who recieved inpatient hydration plus N-acetylcysteine developed contrast-induced nephropathy and two of 25 (8%) who received standard therapy of inpatient intravenous hydration alone developed contrast-induced nephropathy. There was no statistical difference in incidence of contrast-induced nephropathy between the groups. No statistically significant independent risk factors were identified among the patients who developed contrast-induced nephropathy. N-Acetylcysteine did not confer additional benefit to patients treated with inpatient intravenous hydration. Outpatient oral hydration plus N-acetylcysteine was as effective at preventing contrast-induced nephropathy as inpatient therapies and avoided costly hospital admission.
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