Efficacy of N-acetylcysteine and hydration versus placebo and hydration in decreasing contrast-induced renal dysfunction in patients undergoing coronary angiography with or without concomitant percutaneous coronary intervention

Heart Lung. May-Jun 2007;36(3):195-204. doi: 10.1016/j.hrtlng.2006.08.004.

Abstract

Objective: Contrast-induced renal dysfunction is an iatrogenic complication that occurs more frequently in patients with preexisting renal dysfunction. A prospective, double-blind, randomized, placebo, controlled trial was completed to assess the efficacy of N-acetylcysteine in decreasing the incidence of contrast-induced renal dysfunction in patients with an acute coronary syndrome and renal insufficiency who underwent coronary angiography with or without percutaneous coronary intervention.

Methods: With similar intravenous hydration protocols, 20 patients received N-acetylcysteine (treatment group) and 20 patients received placebo (control group) in a twice per day dosing regimen with one dose before and three doses after contrast media exposure.

Results: The two groups were similar at baseline on demographic and clinical characteristics, and preexisting renal insufficiency. Contrast-induced renal dysfunction, defined as an increase in serum creatinine greater than 44 micromol/L (.5 mg/dL) and/or 25% above baseline within 48 hours, occurred in 7.5% of the cohort, with 2.5% in the treatment group, and 5% in the control group, for an absolute difference of 2.5%. There was no difference in serum creatinine or creatinine clearance at 24 hours or at 48 hours between the treatment and control groups.

Conclusion: These results suggest that this cohort gained no added protection to renal function with the use of N-acetylcysteine.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Acetylcysteine / administration & dosage
  • Acetylcysteine / pharmacology*
  • Acetylcysteine / therapeutic use*
  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / prevention & control
  • Aged
  • Angioplasty, Balloon, Coronary
  • Contrast Media / adverse effects*
  • Coronary Angiography / adverse effects*
  • Coronary Angiography / methods
  • Double-Blind Method
  • Female
  • Fluid Therapy*
  • Free Radical Scavengers / administration & dosage
  • Free Radical Scavengers / therapeutic use*
  • Humans
  • Incidence
  • Infusions, Intravenous
  • Male
  • Placebos
  • Risk Factors
  • Sodium Chloride / administration & dosage

Substances

  • Contrast Media
  • Free Radical Scavengers
  • Placebos
  • Sodium Chloride
  • Acetylcysteine