Preventing Contrast-Induced Acute Kidney Injury in Egyptian Patients Undergoing Coronary Angiography: A Randomized...

Area of Science:

• Nephrology
• Cardiology
• Pharmacology

Background:

• Contrast-induced acute kidney injury (CI-AKI) is a significant complication following coronary angiography (CAG).
• Preventive strategies for CI-AKI are crucial, especially in patients undergoing elective CAG.
• Limited evidence exists on effective CI-AKI prevention methods in this patient population.

Purpose of the Study:

• To compare the efficacy of high-dose N-acetylcysteine (NAC) plus hydration versus high-dose atorvastatin (HDS) plus hydration versus hydration alone in preventing CI-AKI.
• To evaluate CI-AKI prevention strategies in patients undergoing elective coronary angiography.
• To assess the impact of NAC and HDS on CI-AKI incidence post-CAG.

Main Methods:

• A prospective, multi-armed randomized comparative study involving 120 patients undergoing elective CAG.
• Patients were assigned to three groups: control (hydration), NAC (1200 mg daily for 5 days + hydration), or HDS (80 mg atorvastatin 24h prior + hydration).
• CI-AKI was defined as a serum creatinine increase >25% or 0.5 mg/dL within 48 hours post-procedure.

Main Results:

• The incidence of CI-AKI was 32.5% in the control group, 20% in the NAC group, and 12.5% in the HDS group.
• High-dose atorvastatin significantly reduced CI-AKI incidence compared to the control group (RR = 1.658).
• No statistically significant differences in in-hospital clinical outcomes were observed among the three groups.

Conclusions:

• Both N-acetylcysteine and high-dose atorvastatin show potential in reducing CI-AKI incidence following coronary angiography.
• High-dose statins appear to be more effective than NAC in preventing CI-AKI.
• Prophylactic strategies, particularly high-dose statins, are supported for CI-AKI prevention in high-risk patients undergoing CAG.