Acetylcysteine in the prevention of contrast-induced nephropathy after coronary angiography

Oldemeyer, J. Bradley; Biddle, William; Wurdeman, Richard L.; Mooss, Aryan N.; Cichowski, Erica; Hilleman, Daniel E.

doi:10.1016/s0002-8703(03)00511-8

Cited by 93 publications

(68 citation statements)

References 18 publications

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“…25 Considering all the studies, neither oral nor intravenous NAC should be routinely prescribed for CIN prophylaxis. 26,27 As reported in many studies, we also found that NAC did not confer any benefit over saline alone.…”

Section: Discussionsupporting

confidence: 82%

Does Nebivolol Prevent Contrast‐Induced Nephropathy in Humans?

Günebakmaz

Kaya

Koç

et al. 2012

Clinical Cardiology

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Background:An experimental study showed that nebivolol is an effective agent in contrast‐induced nephropathy (CIN) prophylaxis.Hypothesis:We hypothesized that prophylactic nebivolol use had protective effects on renal function in human beings subjected to iodinated contrast agent since it has vasodilatory effect and antioxidant properties.Methods:The present study enrolled 120 patients scheduled for coronary angiography and ventriculography. All patients were hydrated with intravenous isotonic saline. The patients in group I received 600 mg N‐acetylcysteine every 12 hours for 4 days. The patients in group II received 5 mg nebivolol every 24 hours for 4 days. The patients in group III were only hydrated. The primary endpoint was the occurrence of CIN. The secondary endpoint was the change in serum creatinine (Cr) levels at 2 days and 5 days after the contrast exposure.Results:Nine (22.5%) patients in group I developed CIN, as did 8 patients (20.0%) in group II and 11 patients (27.5%) in group III (P = 0.72). Changes in mean Cr level from baseline to day 2 were not statistically significant in all groups. However, we detected a statistically significant increase in mean Cr levels at day 5 compared with baseline levels in group I and group III (from 1.42 ± 0.13 to 1.52 ± 0.26, p2 = 0.02; and from 1.43 ± 0.14 to 1.55 ± 0.30, p2 = 0.01, respectively). Although an increase was detected in mean Cr level from baseline to the 5‐day Cr level in group II, this did not reach statistical significance (from 1.40 ± 0.12 to 1.48 ± 0.23, P = 0.06).Conclusions:Pretreatment with nebivolol is protective against nephrotoxic effects of contrast media. © 2012 Wiley Periodicals, Inc.The authors have no funding, financial relationships, or conflicts of interest to disclose.

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Section: Discussionsupporting

confidence: 82%

Does Nebivolol Prevent Contrast‐Induced Nephropathy in Humans?

Günebakmaz

Kaya

Koç

et al. 2012

Clinical Cardiology

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“…However, only 2 patients (0.5%) in our study met criteria for the RISK stage of kidney injury using the RIFLE criteria, and none manifested more advanced kidney injury. This suggests that the use of small changes in Scr to estimate sample size requirements, although helping to ensure a sufficient number of primary study "events," likely results in inadequate power to assess clinically meaningful outcomes (23)(24)(25)(26)(27)(28). We conducted post hoc analyses to determine the sample size requirements of a clinical trial testing a hypothetical intervention that would reduce the incidence of CIAKI, from 3.5%, which was the incidence in our study using a definition of an increase in Scr Ն0.5 mg/dl, to 1.75%.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes of Contrast-Induced AKI Following Computed Tomography

Weisbord

Mor

Resnick

et al. 2008

Clinical Journal of the American Society of Nephrology

180

127

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Background and objectives: Most studies of contrast-induced acute kidney injury (CIAKI) have focused on patients undergoing angiographic procedures. The incidence and outcomes of CIAKI in patients undergoing nonemergent, contrastenhanced computed tomography in the inpatient and outpatient setting were assessed.Design, setting, participants, & measurements: Patients with estimated glomerular filtration rates (GFRs) <60 ml/min per 1.73 m 2 undergoing nonemergent computed tomography with intravenous iodinated radiocontrast at an academic VA Medical Center were prospectively identified. Serum creatinine was assessed 48 to 96 h postprocedure to quantify the incidence of CIAKI, and the need for postprocedure dialysis, hospital admission, and 30-d mortality was tracked to examine the associations of CIAKI with these medical outcomes.Results: A total of 421 patients with a median estimated GFR of 53 ml/min per 1.73 m 2 were enrolled. Overall, 6.5% of patients developed an increase in serum creatinine >25%, and 3.5% demonstrated a rise in serum creatinine >0.5 mg/dl. Although only 6% of outpatients received preprocedure and postprocedure intravenous fluid, <1% of outpatients with estimated GFRs >45 ml/min per 1.73 m 2 manifested an increase in serum creatinine >0.5 mg/dl. None of the study participants required postprocedure dialysis. Forty-six patients (10.9%) were hospitalized and 10 (2.4%) died by 30-d follow-up; however, CIAKI was not associated with these outcomes.Conclusions: Clinically significant CIAKI following nonemergent computed tomography is uncommon among outpatients with mild baseline kidney disease. These findings have important implications for providers ordering and performing computed tomography and for future clinical trials of CIAKI.

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“…Oldemeyer et al (103) randomized 96 patients having coronary angiography, all with creatinine clearance Ͻ50 ml/min to treatment with NAC 1500 mg orally every 12 h for four doses or placebo. The definition of RCIN was an increase in Scr of 0.5 mg/dl or 25% compared with the baseline value.…”

Section: Other Negative Studiesmentioning

confidence: 99%