Top

CardioVascular and Interventional Radiology

Published in:

01-06-2006 | CLINICAL INVESTIGATIONS

The Role of N-Acetylcysteine in the Prevention of Contrast-Induced Nephrotoxicity

Authors: Caron Sandhu, Anna-Maria Belli, David B. Oliveira

Published in: CardioVascular and Interventional Radiology | Issue 3/2006

Abstract

Purpose

To determine the role of prophylactic N-acetylcysteine in the prevention of contrast-induced nephrotoxicity.

Methods

One hundred and sixteen patients undergoing noncoronary angiography, with or without pre-existing renal impairment, were randomly assigned to receive prophylactic oral N-acetylcysteine or no treatment. Serum creatinine (sCr) was measured prior to angiography and 48 hr after the procedure. Urine samples were collected before and after the examination for measurement of malondialdehyde (MDA) concentration. Contrast-induced nephrotoxicity (CIN) was defined as a rise in serum creatinine of 0.5 mg/dl (44 mmol/l) at 48 hr.

Results

Complete data were available on 106 patients, 53 of whom had received N-acetylcysteine. There were no significant differences between the two groups in baseline characteristics, type of angiogram, or volume and concentration of contrast used. Three patients (2.8%), all of whom had received N-acetylcysteine, developed CIN. In the N-acetylcysteine group, the mean serum creatinine in patients with renal impairment was 151.0 ± 44.2 μmol/l prior to the procedure and 155.6 ± 48.6 μmol/l (p = 0.49) after the procedure. Respective values for those without renal impairment were 79.6 ± 15.1 μmol/l and 81.2 ± 20.0 μmol/l (p = 0.65). In the group that had not received N-acetylcysteine, the mean serum creatinine levels before and after the procedure were 150.0 ± 58.1 and 141.4 ± 48.0 μmol/l (p = 0.17) in patients with renal impairment and 79.7 ± 14.2 and 81.4 ± 15.4 μmol/l (p = 0.34) in those without renal impairment. In both groups, no significant change in urinary MDA concentration was observed.

Conclusion

There is no benefit to the prophylactic administration of N-acetylcysteine in patients undergoing peripheral angiography using current contrast media.

Rihal CS, Textor SC, Grill DE, et al (2002) Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation 105:2259–2264PubMedCrossRef

Lautin EM, Freeman NJ, Schoenfeld AH, et al (1991) Radiocontrast-associated renal dysfunction: Incidence and risk factors. AJR Am J Roentgenol 157:66–68

Cochran ST, Wong WS, Roe DJ (1983) Predicting angiography-induced acute renal function impairment: Clinical risk model. AJR Am J Roentgenol 141:1027–1033PubMed

Manske CL, Sprafka JM, Strony JT, et al (1990) Contrast nephropathy in azotemic diabetic patients undergoing coronary angiography. Am J Med 89:615–620PubMedCrossRef

Parfrey PS, Griffiths SM, Barrett BJ, et al (1989) Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. A prospective controlled study. N Engl J Med 320:143–149PubMed

Caldicott WJ, Hollenberg NK, Abrams HL (1970) Characteristics of response of renal vascular bed to contrast media. Evidence for vasoconstriction induced by the renin–angiotensin system. Invest Radiol 5:539–547PubMed

Katzberg RW, Schulman G, Meggs LG, et al (1983) Mechanism of the renal response to contrast medium in dogs: Decrease in renal function due to hypertonicity. Invest Radiol 18:74–80PubMed

Sherwood T, Lavender JP (1969) Does renal blood flow rise or fall in response to diatrizoate? Invest Radiol 4:327–328PubMed

Bakris GL, Lass N, Gaber AO, et al (1990) Radiocontrast medium-induced declines in renal function: A role for oxygen free radicals. Am J Physiol 258:F115–120PubMed

10.

Yoshioka T, Fogo A, Beckman JK (1992) Reduced activity of antioxidant enzymes underlies contrast media-induced renal injury in volume depletion. Kidney Int 41:1008–1015PubMed

11.

DiMari J, Megyesi J, Udvarhelyi N, et al (1997) N-acetyl cysteine ameliorates ischemic renal failure. Am J Physiol 272:F292–F298PubMed

12.

Bakris GL, Gaber AO, Jones JD (1990) Oxygen free radical involvement in urinary Tamm-Horsfall protein excretion after intrarenal injection of contrast medium. Radiology 175:57–60PubMed

13.

Sandhu C, Newman DJ, Morgan R, et al (2002) The role of oxygen free radicals in contrast-induced nephrotoxicity. Acad Radiol 9 (Suppl 2):S436–437PubMed

14.

Drager LF, Andrade L, Barros de Toledo JF, et al (2004) Renal effects of N-acetylcysteine in patients at risk for contrast nephropathy: Decrease in oxidant stress-mediated renal tubular injury. Nephrol Dial Transplant 19:1803–1807PubMed

15.

Tepel M, van der Giet M, Schwarzfeld C, et al (2000) Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 343:180–184PubMedCrossRef

16.

Shyu KG, Cheng JJ, Kuan P (2002) Acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure. J Am Coll Cardiol 40:1383–1388PubMedCrossRef

17.

Diaz-Sandoval LJ, Kosowsky BD, Losordo DW (2002) Acetylcysteine to prevent angiography-related renal tissue injury (the APART trial). Am J Cardiol 89:356–358PubMedCrossRef

18.

Kay J, Chow WH, Chan TM, et al (2003) Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and intervention: A randomized controlled trial. JAMA 289:553–558PubMed

19.

Durham JD, Caputo C, Dokko J, et al (2002) A randomized controlled trial of N-acetylcysteine to prevent contrast nephropathy in cardiac angiography. Kidney Int 62:2202–2207PubMedCrossRef

20.

Briguori C, Manganelli F, Scarpato P, et al (2002) Acetylcysteine and contrast agent-associated nephrotoxicity. J Am Coll Cardiol 40:298–303PubMed

21.

Allaqaband S, Tumuluri R, Malik AM, et al (2002) Prospective randomized study of N-acetylcysteine, fenoldopam, and saline for prevention of radiocontrast-induced nephropathy. Catheter Cardiovasc Interv 57:279–283PubMed

22.

Fung JW, Szeto CC, Chan WW, et al (2004) Effect of N-acetylcysteine for prevention of contrast nephropathy in patient with moderate to severe renal insufficiency: A randomized trial. Am J Kidney Dis 43:801–808PubMedCrossRef

23.

Birck R, Krzossok S, Markowetz F, et al (2003) Acetylcysteine for prevention of contrast nephropathy: Meta-analysis. Lancet 23:598–603

24.

Alonso A, Lau JB, Jaber BL, et al (2004) Prevention of radiocontrast nephropathy with N-acetylcysteine in patients with chronic kidney disease: A meta-analysis of randomized controlled trials. Am J Kidney Dis 43:1–9PubMedCrossRef

25.

Misra D, Leibowitz K, Gowda RM, et al (2004) Role of N-acetylcysteine in prevention of contrast-induced nephrotoxicity after cardiovascular procedures: A meta-analysis. Clin Cardiol 27:607–610PubMed

26.

Nallamothu BK, Shojania KG, Saint S, et al (2004) Is acetylcysteine effective in preventing contrast-related nephropathy? A meta-analysis. Am J Med 117:938–947PubMedCrossRef

27.

Bagshaw SM, Ghali WA (2004) Acetylcysteine for prevention of contrast-induced nephropathy after intravascular angiography: A systematic review and meta-analysis. BMC Med 22:38

28.

Pannu N, Manns B, Lee H, et al (2004) Systematic review of the impact of N-acetylcysteine on contrast nephropathy. Kidney Int 65:1366–1374PubMedCrossRef

29.

Kshirsagar AV, Poole C, Mottl A, et al (2004) N-acetylcysteine for the prevention of radiocontrast-induced nephropathy: A meta-analysis of prospective controlled trials. J Am Soc Nephrol 15:761–769PubMedCrossRef

30.

Asif A, Epstein M (2004) Prevention of radiocontrast-induced nephropathy. Am J Kidney Dis 44:12–24PubMedCrossRef

31.

Rudnick MR, Goldfarb S, Wexler L, et al (1995) Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: A randomized trial. The Iohexol Cooperative Study. Kidney Int 47:254–261PubMed

32.

Lautin EM, Freeman NJ, Schoenfeld AH, et al (1991) Radiocontrast-associated renal dysfunction: A comparison of lower-osmolality and conventional high-osmolality contrast media. AJR Am J Roentgenol 157:59–65PubMed

33.

Taliercio CP, Vlietstra RE, Ilstrup DM, et al (1991) A randomized comparison of the nephrotoxicity of iopamidol and diatrizoate in high risk patients undergoing cardiac angiography. J Am Coll Cardiol 17:384–390PubMed

34.

Barrett BJ, Parfrey PS, Vavasour HM, et al (1992) Contrast nephropathy in patients with impaired renal function: High versus low osmolar media. Kidney Int 41:1274–1279PubMed

35.

Aspelin P, Aubry P, Fransson SG, et al (2003) Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med 348:491–499PubMedCrossRef

36.

Chalmers N, Jackson RW (1999) Comparison of iodixanol and iohexol in renal impairment. Br J Radiol 72:701–703PubMed

Title: The Role of N-Acetylcysteine in the Prevention of Contrast-Induced Nephrotoxicity
Authors: Caron Sandhu
Anna-Maria Belli
David B. Oliveira
Publication date: 01-06-2006
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 3/2006
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-005-0127-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The Role of N-Acetylcysteine in the Prevention of Contrast-Induced Nephrotoxicity

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2006

The Current Status of the Use of Carbon Dioxide in Diagnostic and Interventional Angiographic Procedures

Palliative Radiofrequency Ablation for Recurrent Prostate Cancer

Splenic Artery Aneurysm of the Anomalous Splenomesenteric Trunk: Successful Treatment by Transcatheter Embolization Using Detachable Coils

Fluoroscopically Guided Feeding Tube Insertion for Relief of Postoperative Gastrointestinal Anastomotic Obstruction and Leakage

Comparison of Fusion Imaging Using a Combined SPECT/CT System and Intra-arterial CT: Assessment of Drug Distribution by an Implantable Port System in Patients Undergoing Hepatic Arterial Infusion Chemotherapy

Percutaneous Treatment of Congenital Splenic Cysts: Drainage and Sclerotherapy with Polidocanol