TY - JOUR
T1 - N-acetylcysteine versus fenoldopam mesylate to prevent contrast agent-associated nephrotoxicity
AU - Briguori, Carlo
AU - Colombo, Antonio
AU - Airoldi, Flavio
AU - Violante, Anna
AU - Castelli, Alfredo
AU - Balestrieri, Pasquale
AU - Paolo Elia, Pietro
AU - Golia, Bruno
AU - Lepore, Stefano
AU - Riviezzo, Guido
AU - Scarpato, Pierfranco
AU - Librera, Mariateresa
AU - Focaccio, Amelia
AU - Ricciardelli, Bruno
PY - 2004/8/18
Y1 - 2004/8/18
N2 - We performed a study to assess the efficacy of fenoldopam mesylate (a specific agonist of the dopamine-1 receptor) as compared with N-acetylcysteine (NAC) in preventing contrast agent-associated nephrotoxicity (CAN). Prophylactic administration of NAC, along with hydration, prevents CAN in patients with chronic renal insufficiency who are undergoing contrast media administration. Preliminary data support the hypothesis that fenoldopam might be as effective as NAC. One hundred ninety-two consecutive patients with chronic renal insufficiency, referred to our institution for coronary and/or peripheral procedures, were assigned randomly to receive 0.45% saline intravenously and NAC (1,200 mg orally twice daily; NAC group; n = 97) or fenoldopam (0.10 μg/kg/min; fenoldopam group; n = 95) before and after a nonionic, iso-osmolality contrast dye administration. Baseline creatinine levels were similar in the two groups: NAC group = 1.72 mg/dl (interquartile range, 1.55 to 1.90 mg/dl) and fenoldopam group = 1.75 mg/dl (interquartile range, 1.62 to 2.01 mg/dl) (p = 0.17). An increase of at least 0.5 mg/dl of the creatinine concentration 48 h after the procedure occurred in 4 of 97 patients (4.1%) in the NAC group and in 13 of 95 patients (13.7%) in the fenoldopam group (p = 0.019; odds ratio 0.27; 95% confidence interval 0.08 to 0.85). The amount of contrast media administration was similar in the two groups (NAC group = 160 ± 82 ml; fenoldopam group = 168 ± 104 ml; p = 0.54). N-acetylcysteine seems to be more effective than fenoldopam in preventing CAN.
AB - We performed a study to assess the efficacy of fenoldopam mesylate (a specific agonist of the dopamine-1 receptor) as compared with N-acetylcysteine (NAC) in preventing contrast agent-associated nephrotoxicity (CAN). Prophylactic administration of NAC, along with hydration, prevents CAN in patients with chronic renal insufficiency who are undergoing contrast media administration. Preliminary data support the hypothesis that fenoldopam might be as effective as NAC. One hundred ninety-two consecutive patients with chronic renal insufficiency, referred to our institution for coronary and/or peripheral procedures, were assigned randomly to receive 0.45% saline intravenously and NAC (1,200 mg orally twice daily; NAC group; n = 97) or fenoldopam (0.10 μg/kg/min; fenoldopam group; n = 95) before and after a nonionic, iso-osmolality contrast dye administration. Baseline creatinine levels were similar in the two groups: NAC group = 1.72 mg/dl (interquartile range, 1.55 to 1.90 mg/dl) and fenoldopam group = 1.75 mg/dl (interquartile range, 1.62 to 2.01 mg/dl) (p = 0.17). An increase of at least 0.5 mg/dl of the creatinine concentration 48 h after the procedure occurred in 4 of 97 patients (4.1%) in the NAC group and in 13 of 95 patients (13.7%) in the fenoldopam group (p = 0.019; odds ratio 0.27; 95% confidence interval 0.08 to 0.85). The amount of contrast media administration was similar in the two groups (NAC group = 160 ± 82 ml; fenoldopam group = 168 ± 104 ml; p = 0.54). N-acetylcysteine seems to be more effective than fenoldopam in preventing CAN.
UR - http://www.scopus.com/inward/record.url?scp=4143104704&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=4143104704&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2004.04.052
DO - 10.1016/j.jacc.2004.04.052
M3 - Article
C2 - 15312855
AN - SCOPUS:4143104704
VL - 44
SP - 762
EP - 765
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 4
ER -