N-Acetylcysteine in the Prevention of Contrast-Induced Nephropathy

Fishbane, Steven

doi:10.2215/cjn.02590607

Cited by 155 publications

(106 citation statements)

References 70 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several recent systematic reviews and meta-analyses have been published on this subject; some of these reports have found no significant benefit for this compound [101], some have concluded that the results are mixed and inconclusive [94], while others have suggested that NAC protects patients from nephropathy [102,103]. Significant reduction of the odds of exacerbations.…”

Section: N-acetylcysteinementioning

confidence: 99%

Clinical and pharmacological aspects of bath salt use: A review of the literature and case reports

Miotto¹,

Striebel²,

Cho

et al. 2013

Drug and Alcohol Dependence

121

View full text Add to dashboard Cite

Abstract:Reactive oxygen species (ROS) are widely believed to cause or aggravate several human pathologies such as neurodegenerative diseases, cancer, stroke and many other ailments. Antioxidants are assumed to counteract the harmful effects of ROS and therefore prevent or treat oxidative stress-related diseases. In this report, recent human studies exploring the efficiency of antioxidants in prevention and treatment of various diseases are reviewed. Few antioxidants including edaravone (for ischemic stroke in Japan), Nacetylcysteine (for acetaminophen toxicity), alfa-lipoic acid (for diabetic neuropathy) and some flavonoids (polyphenolic compounds present in dietary plants), such as micronized purified flavonoid fraction (diosmin and hesperidin) and oxerutins (for chronic venous insufficiency) as well as baicalein and catechins (for osteoarthritis) have found accepted clinical use. However, despite much enthusiasm in the 1980s and 1990s, many well-known agents such as antioxidant vitamins and also more recently developed compounds such as nitrones have not successfully passed the scrutiny of clinical trials for prevention and treatment of various diseases. This has given rise to a pessimistic view of antioxidant therapy, however, the evidence from human epidemiological studies about the beneficial effects of dietary antioxidants and preclinical in vitro and animal data are compelling. We have probably wasted too much time on agents like antioxidant vitamins instead of focusing on more disease specific, target-directed, highly bioavailable antioxidants. We here discuss possible reasons for the lack of success in some clinical trials and seek to provide some suggestions to be considered if antioxidant therapy is to succeed as an effective therapeutic strategy.

show abstract

Section: N-acetylcysteinementioning

confidence: 99%

Clinical and pharmacological aspects of bath salt use: A review of the literature and case reports

Miotto¹,

Striebel²,

Cho

et al. 2013

Drug and Alcohol Dependence

121

View full text Add to dashboard Cite

show abstract

“…55 Since this early report, the numerous clinical studies and meta-analyses performed have yielded conflicting results; however, some have found substantial efficacy for NAC, as illustrated by a recent meta-analysis, 56 and most have found no benefit. 57 Another antioxidant that has been investigated for preventing contrast-induced AKI is ascorbic acid. In a multicenter, blinded, placebo-controlled trial (N=231), oral ascorbic acid (over-the-counter vitamin C) at a dose of 3 g administered the night before the procedure and a dose of 2 g administered twice after the procedure (on the same day) reduced the occurrence of contrast-induced AKI to 9%, compared with 20% with placebo.…”

Section: Minimizing Riskmentioning

confidence: 99%

Contrast-Induced Acute Kidney Injury: Specialty-Specific Protocols for Interventional Radiology, Diagnostic Computed Tomography Radiology, and Interventional Cardiology

Goldfarb

McCullough

McDermott

et al. 2009

Mayo Clinic Proceedings

139

View full text Add to dashboard Cite

Contrast-induced acute kidney injury (AKI) (also known as contrast-induced nephropathy) is an abrupt deterioration in renal function that can be associated with use of iodinated contrast medium. Although the increase in serum creatinine concentration is transient in most cases, contrast-induced AKI may lead to increased morbidity and mortality rates in selected at-risk populations. This review summarizes the findings of a multidisciplinary panel composed of computed tomography radiologists, interventional radiologists, cardiologists, and nephrologists convened to address the specialty-specific issues associated with minimizing the incidence of contrast-induced AKI. As part of this initiative, the panel developed specialty-specific protocols for preventing contrast-induced AKI, taking into account, for example, the variations in patient risk profile, inpatient or outpatient status, and staffing resources that characterize various clinical settings. The 3 protocols, each reflecting a consensus of expert opinion, address the prevention of contrast-induced AKI in interventional radiology, diagnostic computed tomography radiology, and interventional cardiology settings. The protocols are presented in the context of a review of recent guidelines and published reports of trials that discuss contrast-induced AKI and its prevention. © 2009 Mayo Foundation for Medical Education and ResearchA cute kidney injury (AKI) is a heterogeneous disorder with multiple etiologies, risk factors, and clinical presentations. Although patients with AKI are ultimately cared for by nephrologists, AKI occurs in various clinical settings and is associated with a specific etiology in each. The term contrast-induced AKI refers to the disorder as it occurs after exposure to iodinated contrast media, a disorder that has been more commonly known as contrastinduced nephropathy (CIN). The Acute Kidney Injury Network, recognizing the need for improving outcomes associated with the various forms of AKI, recently proposed using the following standardized diagnostic definition in all cases: an abrupt (within 48 hours) reduction in kidney function, evidenced by an increase in the serum creatinine concentration of at least 0.3 mg/dL (to convert to µmol/L, multiply by 88.4) or at least 50% from baseline or a reduction in urine output (documented oliguria of <0.5 mL/kg/h for >6 hours).1,2 The criterion of oliguria does not apply for many cases of contrast-induced AKI because patients are treated with intravenous fluids before and after the procedure with the goal of increasing periprocedural urine output. The most commonly used definition of CIN is an increase from the baseline serum creatinine concentration of at least 0.5 mg/dL or at least 25% within 48 to 72 hours after exposure to contrast media. [3][4][5] Because the medical community is moving to adopt the concept and terminology of the American College of Radiology (ACR) in reference to studies of contrast-induced renal dysfunction and its prevention, 6 this report will do the same. However, we rec...

show abstract

“…Therefore, it has been postulated that the mechanism of action may be indirect, and the cysteine metabolite of NAC may stimulate glutathione synthesis, which then inhibits cellular oxidation. 21 The first clinical trial to address the prophylactic role of NAC in CN was an RCT of 83 patients with CRI (mean serum creatinine [Cr] ¼ 2.4) undergoing CT scans, who were randomized to NAC plus 0.45% NaCl vs. placebo and 0.9% NaCl. 22 The NAC dose was 600 mg orally twice daily for 2 doses before and 2 doses after the procedure.…”

Section: Oral N-acetylcysteinementioning

confidence: 99%

Evidence‐based approach for prevention of radiocontrast‐induced nephropathy

Jawdeh

Kanso

Schelling

2009

Journal of Hospital Medicine

View full text Add to dashboard Cite

Disclosure: Nothing to report.The frequency of radiocontrast administration is dramatically increasing, with over 80 million doses delivered annually worldwide. Although recently developed radiocontrast agents are relatively safe in most patients, contrast nephropathy (CN) is still a major source of in-hospital and long-term morbidity and mortality, particularly in patients with preexisting kidney disease. Multiple protocols for CN prevention have been studied; however, strict guidelines have not been established, in part because of conflicting efficacy data for most prevention approaches. In this work, we critically review the major trials that have addressed common CN prophylaxis strategies, including type of radiocontrast media, N-acetylcysteine administration, extracellular fluid volume expansion, and hemofiltration/hemodialysis. We conclude with evidence-based recommendations for CN prevention, which emphasize concurrent NaHCO 3 infusion and N-acetylcysteine administration. These guidelines should be helpful to hospitalists, who frequently order radiocontrast studies, and could therefore have a significant impact on prevention of CN. KEYWORDS: acute kidney injury, N-acetylcysteine, NaHCO 3 , nephrotoxicity, radioiodinated contrast.Since contrast nephropathy (CN) was recognized more than 50 years ago, 1 there have been continuous efforts to chemically modify radiocontrast agents to be less nephrotoxic. Although radiocontrast media have indeed become safer, which reduces the likelihood of CN per procedure, the indications for radiocontrast administration have dramatically increased, since over 80 million doses are delivered in the world annually. 2,3 Furthermore, the number of patients with CN risks, which are mainly chronic renal insufficiency (CRI) and diabetes (Table 1), has also grown. Currently, more than 26 million people are estimated to have CRI in the United States 4 and 200 million people have diabetes worldwide. 5The combination of increased radiocontrast administration frequency and greater prevalence of at-risk patients is likely to result in continued increases in CN events. The incidence of CN varies between studies, depending on risk factors of the cohort and definition of CN, but figures have been reported to be as high as 50% in studies enriched with CRI and diabetic patients. However, a very recent study disputes such high incidence rates by demonstrating that patients receiving no radiocontrast media had a similar frequency of serum creatinine increases compared to a comparable group of historical CN patients. 6 This study emphasizes that conventional definitions of CN, eg, 25% increase in serum creatinine above baseline, may be too conservative. A retrospective study of 7586 patients showed 22% inhospital mortality in patients who developed CN vs. 1.4% in those who did not, after adjusting for comorbidities. Oneand 5-year mortality rates were also higher in the CN group (12.1% vs. 3.7% and 44.6% vs. 14.5%, respectively). 7 Another study of 1826 patients, who underwent coronary artery inte...

show abstract

N-Acetylcysteine in the Prevention of Contrast-Induced Nephropathy

Cited by 155 publications

References 70 publications

Clinical and pharmacological aspects of bath salt use: A review of the literature and case reports

Clinical and pharmacological aspects of bath salt use: A review of the literature and case reports

Contrast-Induced Acute Kidney Injury: Specialty-Specific Protocols for Interventional Radiology, Diagnostic Computed Tomography Radiology, and Interventional Cardiology

Evidence‐based approach for prevention of radiocontrast‐induced nephropathy

Contact Info

Product

Resources

About