Acetylcysteine In Diabetes (AID): a randomized study of acetylcysteine for the prevention of contrast nephropathy in diabetics

Am Heart J. 2006 May;151(5):1032.e9-12. doi: 10.1016/j.ahj.2006.02.002.

Abstract

Background: Patients with diabetes mellitus (DM) are at increased risk of contrast-associated nephropathy irrespective of their baseline creatinine (Cr). We tested the efficacy of N-acetylcysteine (NAC) relative to hydration in unselected patients (irrespective of baseline Cr) with DM.

Methods: We conducted a randomized open-label study comparing hydration alone (combined oral and rapid intravenous hydration, n = 69) to NAC plus hydration (similar hydration protocol plus NAC 600 mg BID x 4 doses, n = 68) in diabetic patients (mean age 65 +/- 10 years, 65% men) undergoing elective coronary angiography. The primary end point was the mean change in serum Cr measured up to 96 hours postangiography.

Results: Baseline Cr was 1.14 +/- 0.43 mg/dL (Cr > or = 1.3 mg/dL in 37 subjects). Baseline characteristics including blood urea nitrogen, Cr, and contrast volume were similar between the 2 groups. The mean Cr change in the NAC group was 0.14 +/- 0.47 versus 0.08 +/- 0.11 mg/dL in the hydration only group (P = NS). Contrast-associated nephropathy, defined as a > or = 0.5 mg/dL increase in Cr, was significantly more common in the NAC group, 9.2% versus 1.4%, P = .043. Similar results were found in the subgroup of participants with either an increased baseline serum Cr (> or = 1.3 mg/dL) or in those receiving high contrast volumes (> 100 mL).

Conclusions: N-Acetylcysteine provides no benefit over an aggressive hydration protocol in patients with DM undergoing coronary angiography.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetylcysteine / administration & dosage
  • Acetylcysteine / therapeutic use*
  • Administration, Oral
  • Aged
  • Contrast Media / adverse effects*
  • Coronary Angiography
  • Creatinine / blood
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / drug therapy*
  • Drug Administration Schedule
  • Female
  • Humans
  • Incidence
  • Injections, Intravenous
  • Kidney Diseases / chemically induced*
  • Kidney Diseases / epidemiology
  • Kidney Diseases / prevention & control*
  • Male
  • Middle Aged
  • Sodium Chloride / administration & dosage
  • Sodium Chloride / therapeutic use
  • Treatment Failure

Substances

  • Contrast Media
  • Sodium Chloride
  • Creatinine
  • Acetylcysteine