Acetylcysteine for the Prevention of Renal Outcomes in Patients With Diabetes Mellitus Undergoing Coronary and Peripheral Vascular Angiography

Abstract

Acetylcysteine is a safe, inexpensive, and readily available antioxidant that has been proposed as a prophylactic intervention for contrast-induced acute kidney injury on top of optimal hydration. In this regard, several randomized trials were completed and reached inconsistent results. 8,9 Such studies are limited by low statistical power and most failed to meet quality standards, such as allocation concealment, blinding, and intention-to-treat analysis. Systematic reviews have found high heterogeneity across studies, precluding definitive conclusions regarding the efficacy of acetylcysteine. [10][11][12][13][14][15] Despite the independent association between diabetes mellitus and contrast-induced acute kidney injury, to date, no large-scale trial has evaluated the effects of acetylcysteine in these patient population.The Acetylcysteine for Contrast-Induced Nephropathy Trial (ACT) 16 randomized 2308 patients undergoing anBackground-Diabetes mellitus represents an independent risk factor for contrast-induced acute kidney injury. We report the results of a prespecified substudy of patients with diabetes mellitus included in the Acetylcysteine for Contrast-Induced Nephropathy Trial (ACT), the largest randomized study evaluating the effects of acetylcysteine for the prevention of contrast-induced acute kidney injury conducted to date. Methods and Results-From the 2308 patients included in the ACT, 1395 had diabetes mellitus and were considered for the present analysis. The study drugs (acetylcysteine 1200 mg or matching placebo) were administered orally twice daily for 2 doses before and 2 doses after the procedure. The allocation was concealed (central Web-based randomization). Participants, healthcare staff, data collectors, and outcome assessors were blinded. All analysis followed the intention-totreat principle. The incidence of contrast-induced acute kidney injury (primary end point) was 13.8% in the acetylcysteine group and 14.7% in the control group (relative risk 0.93; 95% confidence interval, 0.

Post-contrast acute kidney injury. Part 2: risk stratification, role of hydration and other prophylactic measures, patients taking metformin and chronic dialysis patients

“…Most recent RCTs or meta-analyses do not show a protective effect of NAc against PC-AKI following coronary or peripheral angiography [ 66 , 80 – 84 ]. NAc also failed to affect clinical outcome in coronary or peripheral angiography [ 85 ] or to have a protective effect in CT [ 86 , 87 ] or in patients with diabetes mellitus undergoing coronary or peripheral angiography [ 88 , 89 ]. Comparative studies with NAc combined with saline or sodium bicarbonate protocols did not show any additional effect of protective effect of NAc [ 61 , 90 – 93 ].…”

Latest Clinical Evidence About Effect of Acetylcysteine on Preventing Contrast-Induced Nephropathy in Patients Undergoing Angiography: A Meta-Analysis

“…All studies were RCTs. Fifty-five studies 12, provided the process of random allocation concealment and sequence generation; 21 studies 17,21,22,24,25,27,29,30,33,37,38,41,43,44,46,48,59,60,63,67,68 mentioned blinding of personnel and subjects and 21 studies 17,21,22,24,25,27,29,30,33,37,38,41,43,44,46,48,59,60,63,67,68 mentioned blinding of outcome assessment. No study mentioned the existence of bias.…”

Effect of Iodinated Contrast Medium in Diabetic Rat Kidneys as Evaluated by Blood-Oxygenation-Level–Dependent Magnetic Resonance Imaging and Urinary Neutrophil Gelatinase-Associated Lipocalin

“…Clinical studies have shown diabetes mellitus as an independent risk factor for CIAKI 12 due to enhanced renal medullary hypoxia and impaired endothelium-derived vasorelaxation. Previous pre-clinical studies have used a functional CIAKI model by simulating endothelial dysfunction by pre-treating rats with L-NAME (nitric oxide synthase inhibitor) and indomethacin (prostaglandin inhibitor).…”