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The Role of N-Acetylcysteine in the Prevention of Contrast-Induced Nephrotoxicity

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Abstract

Purpose

To determine the role of prophylactic N-acetylcysteine in the prevention of contrast-induced nephrotoxicity.

Methods

One hundred and sixteen patients undergoing noncoronary angiography, with or without pre-existing renal impairment, were randomly assigned to receive prophylactic oral N-acetylcysteine or no treatment. Serum creatinine (sCr) was measured prior to angiography and 48 hr after the procedure. Urine samples were collected before and after the examination for measurement of malondialdehyde (MDA) concentration. Contrast-induced nephrotoxicity (CIN) was defined as a rise in serum creatinine of 0.5 mg/dl (44 mmol/l) at 48 hr.

Results

Complete data were available on 106 patients, 53 of whom had received N-acetylcysteine. There were no significant differences between the two groups in baseline characteristics, type of angiogram, or volume and concentration of contrast used. Three patients (2.8%), all of whom had received N-acetylcysteine, developed CIN. In the N-acetylcysteine group, the mean serum creatinine in patients with renal impairment was 151.0 ± 44.2 μmol/l prior to the procedure and 155.6 ± 48.6 μmol/l (p = 0.49) after the procedure. Respective values for those without renal impairment were 79.6 ± 15.1 μmol/l and 81.2 ± 20.0 μmol/l (p = 0.65). In the group that had not received N-acetylcysteine, the mean serum creatinine levels before and after the procedure were 150.0 ± 58.1 and 141.4 ± 48.0 μmol/l (p = 0.17) in patients with renal impairment and 79.7 ± 14.2 and 81.4 ± 15.4 μmol/l (p = 0.34) in those without renal impairment. In both groups, no significant change in urinary MDA concentration was observed.

Conclusion

There is no benefit to the prophylactic administration of N-acetylcysteine in patients undergoing peripheral angiography using current contrast media.

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Acknowledgments

The authors would like to acknowledge the help of the staff of the surgical vascular unit, blood pressure unit and angiography suite at St. George’s Hospital. Special thanks also go to the late Dr. D.J. Newman for performing all the laboratory analyses.

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Authors and Affiliations

  1. Department of Radiology, Guy’s and St. Thomas’s Hospital, London, SE1 9RT, UK

    Caron Sandhu

  2. Department of Radiology, St. George’s Hospital, Blackshaw Road, London, SW17 OQT, UK

    Anna-Maria Belli

  3. Department of Renal Medicine, St. George’s Hospital, Blackshaw Road, London, SW17 OQT, UK

    David B. Oliveira

Authors
  1. Caron Sandhu
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  2. Anna-Maria Belli
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  3. David B. Oliveira
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Correspondence to Caron Sandhu.

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Sandhu, C., Belli, AM. & Oliveira, D.B. The Role of N-Acetylcysteine in the Prevention of Contrast-Induced Nephrotoxicity. Cardiovasc Intervent Radiol 29, 344–347 (2006). https://doi.org/10.1007/s00270-005-0127-8

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