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Thiol-Containing Antioxidant Shows Promise in Preventing Contrast Nephropathy
Lancet
08/25/2003
By Joene Hendry
Treatment with acetylcysteine, a thiol-containing antioxidant, shows promise in preventing contrast nephropathy in patients with chronic renal insufficiency according to the findings of a meta-analysis of randomised controlled trials comparing acetylcysteine with hydration therapy.
"The reported association of contrast nephropathy with increased morbidity, mortality, and lengthened hospital stay might justify use of acetylcysteine for prophylaxis of contrast nephropathy," writes Rainer Birck, MD, University Hospital Mannheim, Germany, and colleagues. They analysed data from 7 trials including 805 patients with chronic renal insufficiency treated with acetylcysteine and hydration therapy or hydration therapy alone for the prevention of contrast nephropathy.
The patients had a mean serum creatinine of 123.76 to 247.52 micromoles/L and used standard periprocedural hydration regimens. The patients received non-ionic radiocontrast media in mean amounts ranging from 75 mL to 187 mL mostly for scheduled cardiac interventions.
The patients, 57% to 90% male, were a mean age of 69 years and between 21% and 64% had diabetes. Overall, 403 patients were randomised to slightly differing regimens and formulations of oral acetylcysteine combined with intravenous hydration while 402 patients underwent intravenous hydration alone. The overall incidence of contrast nephropathy ranged from 8% to 28% of the patient population.
When the researchers combined the effect sizes of the 7 trials through a random-effects model they recorded a 56% relative risk reduction in contrast nephropathy for patients given acetylcysteine. "Meta-regression revealed no significant relation between the relative risk of contrast nephropathy and the volume of radiocontrast media administered or the degree of chronic renal insufficiency before the procedure," Dr. Birck and colleagues note.
They conclude that trials are warranted designed to "investigate the course of serum creatinine after radiocontrast media application and to elucidate the effect of acetylcysteine on hard clinical endpoints."
Lancet 2003;362:598-603.
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