Prevention of contrast-induced nephropathy in vascular surgery patients

Ann Vasc Surg. 2007 Sep;21(5):593-7. doi: 10.1016/j.avsg.2007.07.006.


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.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetylcysteine / therapeutic use
  • Ambulatory Care
  • Aneurysm / diagnostic imaging
  • Angiography
  • Contrast Media / administration & dosage
  • Contrast Media / adverse effects*
  • Creatinine / blood
  • Female
  • Fluid Therapy
  • Follow-Up Studies
  • Free Radical Scavengers / therapeutic use
  • Hospitalization
  • Humans
  • Kidney Diseases / chemically induced
  • Kidney Diseases / prevention & control*
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / physiopathology
  • Male
  • Peripheral Vascular Diseases / diagnostic imaging
  • Placebos
  • Prospective Studies
  • Risk Factors
  • Vascular Surgical Procedures*


  • Contrast Media
  • Free Radical Scavengers
  • Placebos
  • Creatinine
  • Acetylcysteine