The impact of N-acetylcysteine and ascorbic acid in contrast-induced nephropathy in critical care patients: an open-label randomized controlled study

Crit Care. 2017 Oct 31;21(1):269. doi: 10.1186/s13054-017-1862-3.

Abstract

Background: The aim was to investigate whether the use of N-acetylcysteine and ascorbic acid reduce contrast-induced nephropathy incidence in critical care patients.

Methods: This was a one-center, two-arm, prospective, randomized, open-label, controlled trial in the Intensive Care Unit of the University Hospital of Larissa, Greece. Patients with stable renal function, who underwent non urgent contrast-enhanced computed tomography for diagnostic purposes, were included in the study. Patients in the treatment group (NacA, n = 60) received intravenously N-acetylcysteine (1200 mg) and ascorbic acid (2 g) dissolved separately in 100 ml of normal saline 2 hours before, and at 10 hours and 18 hours following the infusion of contrast agent, while control group patients (CG, n = 64) received only normal saline. All patients received additional hydration. Contrast-induced nephropathy was defined as relative increase by 25% of the baseline values of serum creatinine.

Results: Contrast-induced nephropathy in NacA and CG were 18.33% and 15.6%, respectively (p = 0.81). The percentage change median (interquartile range (IR)) of serum cystatin-C (mg/L) from baseline in patients who underwent contrast-induced tomography, were 37.23% (28.53) and 93.20% (46.90) in NacA and in CG, respectively (p = 0.03). The 8-isoprostane serum levels in NacA were significantly lower compared to CG at 2 hours (p = 0.012) and 24 hours (p = 0.006) following radiocontrast infusion. Multivariate analysis revealed that contrast-induced nephropathy was independently associated with a higher baseline ratio of serum urea/creatinine (odds ratio, 1.02; 95 CI%, 1.00-1.05) and with the use of nephrotoxic medications (odds ratio, 0.24; 95 CI%, 0.06-0.94).

Conclusion: Intravenous administration of N-acetylcysteine and ascorbic acid failed to reduce contrast-induced nephropathy in critically ill patients who underwent contrast-enhanced computed tomography, despite a significant reduction of 8-isoprostane levels in treated patients.

Trial registration: ClinicalTrials.gov, NCT01017796 . Registered on 20 November 2009.

Keywords: 8-Isoprostane; Ascorbic acid; Contrast induced nephropathy; Intensive care; N-acetylcysteine; cystatin-C.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetylcysteine / pharmacology*
  • Acetylcysteine / therapeutic use
  • Acute Kidney Injury / drug therapy
  • Acute Kidney Injury / etiology*
  • Acute Kidney Injury / prevention & control
  • Administration, Intravenous
  • Ascorbic Acid / pharmacology*
  • Ascorbic Acid / therapeutic use
  • Blood Urea Nitrogen
  • Contrast Media / adverse effects*
  • Creatinine / analysis
  • Creatinine / blood
  • Critical Care / methods
  • Female
  • Greece
  • Humans
  • Intensive Care Units / organization & administration
  • Kidney / drug effects*
  • Kidney / injuries
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prospective Studies
  • ROC Curve
  • Statistics, Nonparametric
  • Tomography, X-Ray Computed / adverse effects
  • Tomography, X-Ray Computed / methods

Substances

  • Contrast Media
  • Creatinine
  • Ascorbic Acid
  • Acetylcysteine

Associated data

  • ClinicalTrials.gov/NCT01017796