N-acetylcysteine and/or ascorbic acid versus placebo to prevent contrast-induced nephropathy in patients undergoing elective cardiac catheterization: The NAPCIN trial; A single-center, prospective, randomized trial

Abstract

Several protective measures have been described to prevent contrast-induced nephropathy (CIN). This study is aimed to evaluate the effect of a high dose of N-acetylcysteine (NAC) plus hydration, a low dose of NAC plus ascorbic acid and hydration or hydration alone on the prevention of CIN in high-risk patients undergoing elective coronary artery intervention. We conducted a randomized, prospective, placebo-controlled trial of 105 high-risk patients undergoing elective cardiac catheterization. The patients were divided into three different groups: Group A (n=30), NAC 1200 mg orally before angiography and 1200 mg orally twice daily for three doses along with good hydration; Group B (n=30), NAC 600 mg before angiography and 600 mg orally twice daily for three doses plus ascorbic acid (3000 mg one dose) before angiography and 2000 mg two doses after angiography and good hydration; and Group C (n=45), hydration with 0.9% saline started just before contrast media injection and continued for 12 h at a rate 1.0 mL/kg//min after angiography or 0.5 mL/kg/h in cases with overt heart failure for 12 h. CIN was defined as an increase in serum creatinine of >25% of baseline or an absolute increase of 0.5 mg/dL above baseline after 48 h. The incidence of CIN was significantly lower in Group A (6.66%) compared with Group B (16.66%) or Group C (17.77%). The difference between Groups A and B and between Groups A and C was also highly significant (P=0.001). In contrast, the difference between Groups B and C was not statistically significant (P=0.37). Our study indicates that high doses of NAC plus hydration provide better protection against CIN than combination therapy of NAC and ascorbic acid plus hydration, or hydration alone.

N‐acetylcysteine versus ascorbic acid or N‐acetylcysteine plus ascorbic acid in preventing contrast‐induced nephropathy: A meta‐analysis

“…Among the included studies, the study of Jo et al . and Habib et al . showed high‐dose NAC administration (1200 mg) significantly decreased CIN incidence compared with VC administration, which was inconsistent with our results.…”

“…Meanwhile, the subgroup analyses for serum creatinine levels also showed that patients with NAC administration had significant lower serum creatinine levels compared to VC and NAC + VC administration. It indicated that NAC administration seems more beneficial than VC in the decrease of serum creatinine levels, which was in line with the recent study . However, some other previous studies reported that NAC has no effect on serum creatinine .…”

“…showed the different efficacy of NAC versus VC treatment on the patients; while Briguori et al . and Habib et al . evaluated the efficacy of NAC versus NAC + VC treatment on preventing CIN.…”

“…The characteristics of included six studies 19,20,[26][27][28][29] are presented in Table 1. The included studies were published from 2007 to 2016.…”

“…Among the six included studies, Albabtain and colleagues 19 investigated the effect of NAC, VC and NAC + VC on the prevention of CIN. Simultaneously, Brueck et al, 27 Jo et al 20 and Khaledifar et al 28 showed the different efficacy of NAC versus VC treatment on the patients; while Briguori et al 26 and Habib et al 29 evaluated the efficacy of NAC versus NAC + VC treatment on preventing CIN. Also, there were differences in administration of NAC and VC among the six included trails.…”