Acetylcysteine and non-ionic isosmolar contrast-induced nephropathy - A randomized controlled study

Introduction. Intravenous administration of saline and non-ionic isosmolar contrast media significantly reduces the incidence of contrast-induced nephropathy, one of the most common causes of acute renal failure. Results with oral N-acetylcysteine are conflicting. The aim of our study was to evaluate the prophylactic role of N-acetylcysteine in patients with stable chronic renal failure undergoing coronary andor peripheral angiography andor angioplasty.Methods. We randomized 200 elective, consecutive patients (mean age 74.9 ± 7.3 years; 65 male, 25 diabetics) with basal creatinine clearance ≤55 mlmin to receive oral N-acetylcysteine (600 mg bid the day before and the day of the procedure plus saline i.v. 0.9 1 mlkgh 12-24 h before and 24 h after the procedure, n = 99) or placebo and saline at the same time intervals, n = 101. The contrast medium was non-ionic isosmolar (Iodixanol, Visipaque Amersham Health). Contrast-induced nephropathy was defined as an increase in serum creatinine >0.5 mgdl or >25 within 3 days after the procedure. Serum creatinine was measured at baseline, 24, 48 and 72 h after the procedure.Results. Contrast-induced nephropathy was 899 (8.1) in the N-acetylcysteine group versus 6101 (5.9) in the placebo group, P = 0.6. No difference was noted in high-risk subgroups such as diabetics (425 versus 225 P = 0.4) and those with serum creatinine clearance