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Acetylcysteine for Prevention of Contrast-Induced Nephropathy

Summary and Comment |
October 31, 2013

Acetylcysteine for Prevention of Contrast-Induced Nephropathy

  1. Daniel J. Pallin, MD, MPH

Hydration with normal saline alone may be the best approach for most patients.

  1. Daniel J. Pallin, MD, MPH

Many studies have evaluated approaches to prevention of contrast-induced nephropathy (CIN), including oral or intravenous hydration, bicarbonate infusion, and administration of acetylcysteine, an antioxidant and glutathione substitute. These investigators compared IV acetylcysteine plus normal saline to normal saline alone in a randomized trial of emergency department patients undergoing chest or abdominal computed tomography with IV contrast who had at least one risk factor for CIN.

CIN was defined as an increase in creatinine of 25% or 0.5 mg/dL within 48 to 72 hours after contrast administration. The study was stopped early for futility because the incidence of CIN did not differ between groups and the safety monitoring board did not think enrolling more patients would change this observation. Interestingly, patients with a baseline creatinine >1.2 mg/dL benefitted from acetylcysteine, but the study was not designed to be discriminatory in this subgroup and the results were not statistically significant. Aside from acetylcysteine, larger volumes of fluid were protective: The odds for CIN were 0.41 for each liter given.

Comment

The three main candidates for prevention of contrast-induced nephropathy are intravenous normal saline, bicarbonate, and acetylcysteine. Results with acetylcysteine and bicarbonate have been mixed; both may be beneficial for patients who start out with some degree of renal insufficiency, but more research in this group is needed. Because bicarbonate and acetylcysteine are unlikely to be harmful, it may be reasonable to use them in at-risk patients … but don't forget hydration. It is clear that normal saline hydration is valuable, and that more is better.

  • Disclosures for Daniel J. Pallin, MD, MPH at time of publication Grant / research support Agency for Healthcare Research and Quality; Department of Defense; Massachusetts Coalition for the Prevention of Medical Errors; NIH

Citation(s):

Reader Comments (1)

Gutiérrez Myriam Physician, Other, National University of Colombia

Toxicology Consultant : It"s very important this study.
Prevention is very important for patients. That is a good medical practice.

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