Acetylcysteine and non-ionic isosmolar contrast-induced nephropathy--a randomized controlled study

Area of Science:

• Nephrology
• Radiology
• Pharmacology

Background:

• Contrast-induced nephropathy (CIN) is a common cause of acute renal failure.
• Intravenous saline and non-ionic isosmolar contrast media reduce CIN incidence.
• Oral N-acetylcysteine's role in preventing CIN remains debated.

Purpose of the Study:

• To evaluate the prophylactic effect of N-acetylcysteine in patients with stable chronic renal failure undergoing angiography.
• To assess CIN incidence in patients receiving N-acetylcysteine versus placebo.

Main Methods:

• 200 patients with creatinine clearance ≤55 ml/min were randomized.
• Intervention group received oral N-acetylcysteine plus intravenous saline.
• Control group received placebo plus intravenous saline.
• Isosmolar iodixanol contrast media was used.
• CIN defined as serum creatinine increase >0.5 mg/dl or >25% within 3 days.

Main Results:

• CIN occurred in 8.1% of the N-acetylcysteine group and 5.9% of the placebo group (P=0.6).
• No significant difference in CIN was observed in high-risk subgroups like diabetics or those with severe renal impairment.

Conclusions:

• N-acetylcysteine did not prevent contrast-induced nephropathy in this patient cohort.
• Adequate hydration and isosmolar contrast media may be sufficient for prevention.
• Further research may be needed to clarify N-acetylcysteine's role in specific patient populations.