Source: Bone  |  Posted 8 years ago

Prophylactic administration of acetylcysteine reduces the development of contrast-induced nephropathy in patients with mild to moderate renal dysfunction prior to coronary angiography, say American researchers.

Contrast-induced nephropathy (CIN) is an important cause of acute renal failure in patients undergoing cardiac catheterisation. Prehydration and the use of low-osmolality contrast agents may prevent CIN. Evidence suggests that the use of acetylcysteine reduces the incidence of CIN in patients undergoing computed tomography (CT).

In a randomised, double blind trial, Briain D. MacNeill, MD, and colleagues from the Cardiology Division, Massachusetts General Hospital and Harvard Medical School in Boston, United States, examined the prophylactic efficacy of acetylcysteine in decreasing the incidence of CIN in elderly patients with mild to moderate renal insufficiency.

Researchers defined mild to moderate renal dysfunction as a serum creatinine (Cr) >/= 1.5 mg/dL while CIN was defined as a rise in serum creatinine of > 25% from baseline. Prior to cardiac catheterisation, all patients were treated with 0.45% saline at a rate of 1 mL/kg/hr for 12 hr for in-patients and 2 mL/kg/hr for 4 hr for day-case patients. Serum creatinine and urea were measured before and at 24, 48, and 72 hours after the procedure.

Twenty-one patients were randomised to 600 mg of acetylcysteine, and 22 patients to placebo. Each group received 2 doses - first at the time of randomisation, followed by the second dose 4 hours later. Catheterisation was carried out with non-ionic contrast agents (iopromide or ioxilan). The patients received 3 additional doses of acetylcysteine 600 mg or placebo at 12-hr intervals after the catheterisation. All patients received post catheterisation hydration with 0.45% saline at 75 mL/hr for 12 hr.

The results show no significant difference in baseline renal function between patients receiving acetylcysteine, or placebo. The serum creatinine levels remained unchanged in the acetylcysteine group (1.89