Acetylcysteine, coronary procedure and prevention of contrast-induced worsening of renal function

Kefer, Joëlle; Hanet, Claude E.; Boitte, Sabine; Wilmotte, Léon; Kock, Martine De

doi:10.2143/ac.58.6.2005321

Cited by 46 publications

(27 citation statements)

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“…Another reason is the controversial data obtained from orally administered NAC [102] . As in the studies with oral NAC, the results with IV NAC have also been inconsistent [102][103][104][105][106][107][108][109][110] . The clinical trials comparing IV NAC and control groups for RCIN after angiography are shown in Table 5.…”

Section: Nac Treatmentmentioning

confidence: 94%

Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography

Hung¹,

Lin²,

Hung³

et al. 2012

WJC

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Radiocontrast-induced nephropathy (RCIN) is an acute and severe complication after coronary angiography, particularly for patients with pre-existing chronic kidney disease (CKD). It has been associated with both short-and long-term adverse outcomes, including the need for renal replacement therapy, increased length of hospital stay, major cardiac adverse events, and mortality. RCIN is generally defined as an increase in serum creatinine concentration of 0.5 mg/dL or 25% above baseline within 48 h after contrast administration. There is no effective therapy once injury has occurred, therefore, prevention is the cornerstone for all patients at risk for acute kidney injury (AKI). There is a small but growing body of evidence that prevention of AKI is associated with a reduction in later adverse outcomes. The optimal strategy for preventing RCIN has not yet been established. This review discusses the principal risk factors for RCIN, evaluates and summarizes the evidence for RCIN prophylaxis, and proposes recommendations for preventing RCIN in CKD patients undergoing coronary angiography.

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Section: Nac Treatmentmentioning

confidence: 94%

Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography

Hung¹,

Lin²,

Hung³

et al. 2012

WJC

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“…In all but two studies [33,36], NAC was administered orally. In the majority of studies, 2 doses of NAC (600 mg each) were administered on the day before, and on the day of intravenous administration of contrast media.…”

Section: Nacmentioning

confidence: 99%

N-Acetylcysteine and Other Preventive Measures for Contrast-Induced Nephropathy in the Intensive Care Unit

Schultz

Baas²,

Sluijs³

et al. 2006

CMC

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The increase in diagnostic imaging procedures that require infusion of intravenous radiographic contrast has led to a parallel increase in the incidence of contrast-induced nephropathy (CIN). Since CIN accounts for a significant increase of hospital-acquired renal failure, length of stay and mortality, several additive strategies to prevent CIN are presently advocated, including N-acetylcysteine (NAC), sodium bicarbonate, theophylline or fenoldopam, and peri-procedural hemofiltration/hemodialysis. As only one (non-randomized) study has been performed in the intensive care setting, at present it is hard to give firm recommendations on preventive measures for CIN in intensive care patients. Indeed, future studies are needed to determine the true role of the above-mentioned preventive measures in critically ill patients at risk for CIN. Since NAC has only few side-effects, we presently advise NAC as an additive preventive measure in the intensive care setting. Theophylline or sodium bicarbonate hydration are viable options, either in conjunction NAC or as alternatives.

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“…Cumulative dosages varied from 1500 mg to 4800 mg. In all but two studies [28,31], NAC was administered orally.…”

Section: Clinical Trials On Prevention Of Contrast-induced Nephropathymentioning

confidence: 99%

“…Although five trials found a significant protective effect of NAC compared with standard treatment [22,25,27,30,32], eight found no beneficial effect of administration of NAC [13,23,24,26,28,29,31,35]. Possible explanations for these contrasting results are differences in applied hydration regimens, in the patient populations studied and in the volumes of contrast media administered, and variations in the timing and dosing of NAC.…”

Section: Clinical Trials On Prevention Of Contrast-induced Nephropathymentioning

confidence: 99%

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et al. 2005

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An increasing number of diagnostic imaging procedures requires the use of intravenous radiographic contrast agents, which has led to a parallel increase in the incidence of contrast-induced nephropathy. Risk factors for development of contrast-induced nephropathy include pre-existing renal dysfunction (especially diabetic nephropathy and multiple myeloma-associated nephropathy), dehydration, congestive heart failure and use of concurrent nephrotoxic medication (including aminoglycosides and amphotericin B). Because contrast-induced nephropathy accounts for a significant increase in hospital-acquired renal failure, several strategies to prevent contrast-induced nephropathy are currently advocated, including use of alternative imaging techniques (for which contrast media are not needed), use of (the lowest possible amount of) isoosmolar or low-osmolar contrast agents (instead of high-osmolar contrast agents), hyperhydration and forced diuresis. Administration of N-acetylcysteine, theophylline, or fenoldopam, sodium bicarbonate infusion, and periprocedural haemofiltration/haemodialysis have been investigated as preventive measures in recent years. This review addresses the literature on these newer strategies. Since only one (nonrandomized) study has been performed in intensive care unit patients, at present it is difficult to draw firm conclusions about preventive measures for contrast-induced nephropathy in the critically ill. Further studies are needed to determine the true role of these preventive measures in this group of patients who are at risk for contrast-induced nephropathy. Based on the available evidence, we advise administration of Nacetylcysteine, preferentially orally, or theophylline intravenously, next to hydration with bicarbonate solutions.

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Acetylcysteine, coronary procedure and prevention of contrast-induced worsening of renal function

Abstract: Our data do not support the systematic use of acetylcysteine before a coronary procedure in patients with normal renal function or mild to moderate chronic renal failure, to prevent contrast-induced nephropathy.

Cited by 46 publications

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Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography

Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography

N-Acetylcysteine and Other Preventive Measures for Contrast-Induced Nephropathy in the Intensive Care Unit

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