Oral acetylcysteine as an adjunct to saline hydration for the prevention of contrast-induced nephropathy following coronary angiography A randomized controlled trial and review of the current literature

Abstract

Our findings do not support routine prophylactic administration of oral acetylcysteine as an adjunct to saline hydration for the prevention of contrast-induced nephropathy in chronic renal insufficiency patients undergoing coronary angiography.

No Increased Risk for Contrast-Induced Nephropathy after Multiple CT Perfusion Studies of the Brain with a Nonionic, Dimeric, Iso-Osmolal Contrast Medium

“…[16][17][18][19][20][21]36 Intra-arterial injections are mainly used for coronary procedures, but especially cardiac catheterization may impose or cause many conditions that have the potential to diminish renal perfusion and produce an increase in SCr levels, which may erroneously be ascribed to the contrast medium itself. 29 McCullough 11 reported in 2006 lower rates of CIN and smaller increases in SCr levels after intra-arterial injection of iodixanol in a meta-analysis of renal safety of iodixanol compared with LOCM.…”

“…5,15 Many studies have evaluated the renal safety of the nonionic IOCM iodixanol or that of the other nonionic LOCM in patients with impaired renal function [16][17][18][19][20][21][22] but only after intra-arterial contrast injection. Only 3 studies have compared the nephrotoxicity of the dimeric IOCM iodixanol with monomeric CM after intravenous injection.…”

Clinical Pharmacology, Uses, and Adverse Reactions of Iodinated Contrast Agents: A Primer for the Non-radiologist

“…N-acetylcysteine may show the greatest benefit when used in patients with severe preexisting renal dysfunction. 70,71 Furthermore, N-acetylcysteine has a relatively safe toxicity profile. Because its use is unlikely to cause harm and may provide protection against contrast-induced nephropathy, N-acetylcysteine could be considered.…”

Contrast induced nephropathy - cardiologist perspective

“…The most widely accepted protocol is administering 0.45% saline at 1 to 1.5 ml/kg/h beginning 6 -12 h prior to the procedure and continuing for up to 12 h following contrast administration. 21,33,36,43 Current K/DOQI Guideline on prevention of CI-AKI suggests a "good" urine output (>150ml/hour) in the first 6 hours of radiological procedures, which may reduces rate of AKI. In order to achieve urine flow rate of at least 150ml/hour, >1.0-1.5 ml/kg/hour of intravenous fluid had to be administered for 3-12 hours before and 6-12 after contrast-media exposure.…”

“…In most studies, a uniform protocol with half-isotonic (0.45%) saline at a rate of 1 ml/kg/h before and after contrast exposure was employed. 36,37,38 Mueller et al 39 performed a randomized comparison of 2 hydration regimens (isotonic versus half-isotonic) in 1620 patients undergoing coronary angiography. CIN occurred in 0.7% of the patients with 0.9% saline versus 2.0% of those with half-isotonic saline (p=0.04).…”