Prevention of Radiographic-Contrast-Agent–Induced Reductions in Renal Function by Acetylcysteine

Tepel, Martín; Giet, M. van der; Schwarzfeld, C; Laufer, Ulf; Liermann, D.; Zidek, Walter

doi:10.1056/nejm200007203430304

Cited by 1,448 publications

(947 citation statements)

References 27 publications

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“…Preventive measures for CA-AKI are recommended in patients at risk for CA-AKI (eGFR \60 mL/min or creatinine [1.2 mg/dL) and consist of volume loading with isotonic saline or isotonic sodium bicarbonate according to the protocol of Merten et al and/or administration of N-acetylcysteine [26,27].…”

Section: Processes Of Carementioning

confidence: 99%

Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis

et al. 2011

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Intensive care unit (ICU) patients frequently undergo contrast-enhanced radiographic examinations, which carries a risk for development of contrast-associated acute kidney injury (CA-AKI). Data on this in ICU patients are scarce. The aim of this study was therefore to evaluate the epidemiology and short- and long-term outcomes of CA-AKI in ICU patients. A retrospective single-centre cohort study covering the period 1 March 2004 to 31 December 2008 on ICU patients who underwent a radiography examination with parenteral administration of iodinated radio contrast media was conducted. Data analysis included univariate and multivariate analyses of patients with and without CA-AKI. A total of 787 ICU patients were included in the study. CA-AKI occurred in 128 (16.3%) and was associated with higher need for RRT [30 (4.6%) vs. 21 (16.4%), p < 0.001], worse kidney function at discharge, longer length of ICU and hospital stay, and higher 28-day and 1-year mortality [28-day: 86 (13.1%) vs. 46 (35.9%), p < 0.001, and 1-year: 158 (24.0%) vs. 71 (55.5%), p < 0.001]. Higher serum creatinine, lower mean arterial pressure, and administration of diuretics and vasoactive therapy were associated with development of CA-AKI in multivariate analysis. After correction for confounders we found that CA-AKI was associated with 28-day mortality in this cohort of ICU patients (odds ratio = 2.742, 95% confidence interval 1.374-5.471). CA-AKI occurred in one out of six ICU patients who underwent a contrast-enhanced radiography examination and was associated with both short-and long-term worse outcomes such as need for RRT, worse kidney function at discharge, increased length of stay in the ICU and hospital, and mortality

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Section: Processes Of Carementioning

confidence: 99%

Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis

et al. 2011

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“…In a randomized placebo-controlled study of 83 patients exposed to contrast media, prophylactic administration of acetylcysteine along with hydration was superior to hydration alone in prevention of CIN in patients with elevated baseline creatinine level (CIN 2% vs. 21%, respectively; P ¼ 0.01) [58]. These results caused significant enthusiasm among physicians, and acetylcysteine along with hydration has been adopted by many centers as a standard preparation for contrast exposure, especially in high-risk patients.…”

Section: Acetylcysteinementioning

confidence: 99%

Contrast‐induced nephropathy

Pučelíková

Dangas

Mehran

2007

Cathet Cardio Intervent

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Contrast induced nephropathy (CIN) is an iatrogenic disorder, resulting from exposure to contrast media. Contrast-induced hemodynamic and direct cytotoxic effects on renal structures are highly evident in its pathogenesis, whereas other mechanisms are still poorly understood. CIN is typically defined as an increase in serum creatinine by either 0.5 mg/dl or by 25% from baseline within the first 2-3 days after contrast administration. Although rare in the general population, CIN has a high incidence in patients with an underlying renal disorder, in diabetics, and the elderly. The risk factors are synergistic in their ability to produce CIN. The best way to prevent CIN is to identify the patients at risk and to provide adequate peri-procedural hydration. The role of various drugs in prevention of CIN is still controversial and warrants future studies. Despite remaining uncertainty regarding the degree of nephrotoxicity produced by various contrast agents, in current practice non-ionic low-osmolar contrast media are preferred over the high-osmolar contrast media in patients with renal impairment.

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“…There is currently no pharmacological strategy approved by European or American drug agencies for the prevention of acute renal failure following iodine injection [12,13].…”

Section: Discussionmentioning

confidence: 99%

“…Although popular since the study of Tepel et al [13], N-acetylcysteine is not considered effective by most experts. NAC appears to decrease creatinine by a tubular effect and a reduction in muscle production, without exerting any nephron-protective effect [14].…”

Section: Discussionmentioning

confidence: 99%

Implications of Renal Complications In Out Patient Referral for Coronary Angiography: Prospective Observational Study of 98 Cases

Js¹,

Payot²,

Zabalawi³

et al. 2017

J Clin Exp Cardiolog

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The incidence of acute kidney failure remains high, due to the multiplication of interventional procedures on subjects at risk. It increases both morbi-mortality in hospitals and in the long term. The identification of patients atriskis primordial in order to implement the preventiv emeasures, whose expansion remains the 'gold standard'. The realization of a coronary angiography in ambulatory care in this type of patient at risk is possible without increasing renal morbidity, under the cover of a good hydration.Introduction: Acute renal failure is a complication that remains common after injection of contrast agent. It increases both morbidity and hospital mortality in the long term. We wanted to carry out a prospective observational study to evaluate the incidence of renal complications (acute renal failure, dialysis) of patients referred as an outpatient in our center for coronary angiography and who have benefited from measures of prevention of renal toxicity as recommended by learned societies. Methodology:We conducted a prospective study at the Yves Le Foll hospital in Saint Brieuc over a period of 4 months from November 2015 to February 2016, in patients admitted on an outpatient basis for coronary angiography who had previously suspended all drugs with nephrotoxic potential and with hydration surrounding the examination. A survey card was developed to collect, after informed consent, sociodemographic data, risk factors, comorbidities, clinical and paraclinical data. All data was entered and analyzed using SPSS software version 18.0.Results: Ninety-eight patients had an ambulatory coronary angiogram during this period. The sex ratio was 3.66 in favor of the male genus with an average age of 65 years. Three-quarters of the population (71%) had at least one risk factor for contrast-induced nephropathy. The mean clearance values before and after coronary angiography were almost similar (80 μmol/l) without significant variation. No impairment of renal function was observed in patients at risk regardless of the amount of contrast injected (range: between 30 and 277 ml). When patients accumulate risk factors for induced nephropathy in the contrast medium, there is an increase in the blood creatinine level with the number of factors but no significant change (p: 0.24) of renal function after iodine injection. Conclusion:The incidence of acute kidney injury remains high, due to the increase of intervention procedures in subjects at risk. The identification of these patients at risk is paramount in order to implement the preventive measures of which volume expansion remains the gold standard. The realization of an outpatient coronary angiography in this type of patient at risk is feasible without increasing renal morbidity with a good hydration.

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Prevention of Radiographic-Contrast-Agent–Induced Reductions in Renal Function by Acetylcysteine

Abstract: Prophylactic oral administration of the antioxidant acetylcysteine, along with hydration, prevents the reduction in renal function induced by contrast agents in patients with chronic renal insufficiency.

Cited by 1,448 publications

References 27 publications

Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis

Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis

Contrast‐induced nephropathy

Implications of Renal Complications In Out Patient Referral for Coronary Angiography: Prospective Observational Study of 98 Cases

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