PMID- 23138396
OWN - NLM
STAT- MEDLINE
DCOM- 20140122
LR  - 20211021
IS  - 1437-7799 (Electronic)
IS  - 1342-1751 (Linking)
VI  - 17
IP  - 3
DP  - 2013 Jun
TI  - N-acethyl-cysteine reduces the occurrence of contrast-induced acute kidney injury 
      in patients with renal dysfunction: a single-center randomized controlled trial.
PG  - 396-404
LID - 10.1007/s10157-012-0722-3 [doi]
AB  - BACKGROUND: The occurrence of contrast-induced acute kidney injury (CIAKI) has 
      paralleled the increased number of diagnostic interventions requiring 
      radiographic contrast media (CM). Several strategies aimed at preventing renal 
      injury following iodine have been carried out over the last several years. The 
      aim of this study was to evaluate the impact of three different strategies aimed 
      at preventing CIAKI in patients with renal dysfunction (serum creatinine >1.25 
      mg/dl or estimated creatinine clearance <45 ml/min) receiving low osmolar CM for 
      diagnostic-therapeutic procedures. METHODS: Candidates received 154 mmol NaHCO3 
      solution (B0) at a rate of 3 ml/kg/h from at least 2 h before the procedure and 
      at 1 ml/kg/h during and for the next 6-12 h; the same schedule plus 
      N-acethyl-cysteine (NAC) 600 mg twice daily the day before and the day of the 
      procedure (BN) or NAC as above plus 154 mmol NaCl solution at a rate of 3 ml/kg/h 
      from at least 2 h before the procedure and at 1 ml/kg/h during and for the next 
      6-12 h (SN). Serum creatinine (SCr) was measured at baseline and on days 2 or 
      occasionally 3 after CM. The main outcome measure was the occurrence of CIAKI, 
      defined as a >/=25% increase in SCr within 2-3 days of CM. RESULTS: The three 
      groups were similar with regard to age, gender distribution, weight, baseline 
      serum levels of creatinine, sodium, potassium, urate and estimated creatinine 
      clearance. A larger proportion of individuals received ACEIs/ARAs in the BN group 
      (p < 0.05), but in the SN group, more patients declared a past history of acute 
      myocardial infarction or had high blood pressure, and few displayed mild-moderate 
      left ventricular dysfunction (p < 0.05). CIAKI occurred in 24/123 (19.5%) 
      assessable patients (15/42 in the B0 group, 3/43 in the BN group and 6/38 in the 
      SN group; p < 0.01). Thus, 15/42 patients who did not receive NAC developed CIAKI 
      in contrast to 9/81 who did (p < 0.01). Multivariate logistic regression models 
      showed that the use of NAC was the unique factor associated with a statistically 
      significant influence for the occurrence of CIAKI (OR: 0.18; 95% CI: 0.04-0.72; p 
      = 0.016). CONCLUSIONS: The results from this study show that: (1) the occurrence 
      of CIAKI after low-osmolar CM administration is similar to that reported 
      worldwide. (2) NAC-based renoprotective measures are superior for the prevention 
      of CIAKI in patients with previous renal dysfunction. (3) They also demonstrate 
      that bicarbonate expansion alone has limited value in preventing CIAKI. For those 
      individuals at risk, combination prophylaxis including volume expansion plus NAC 
      should be recommended to reduce the chance of overt kidney injury following CM 
      administration.
FAU - Heguilen, Ricardo M
AU  - Heguilen RM
AD  - Division of Nephrology, Hospital Juan A Fernandez, Universidad de Buenos Aires, 
      Paraguay 5259 Floor 3, Apt A, C1425BTG, Buenos Aires, Argentina. 
      rheguilen@hotmail.com
FAU - Liste, Amador A
AU  - Liste AA
FAU - Payaslian, Miguel
AU  - Payaslian M
FAU - Ortemberg, Martin Gabriel
AU  - Ortemberg MG
FAU - Albarracin, Lautaro Martin
AU  - Albarracin LM
FAU - Bernasconi, Amelia Rita
AU  - Bernasconi AR
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20121110
PL  - Japan
TA  - Clin Exp Nephrol
JT  - Clinical and experimental nephrology
JID - 9709923
RN  - 0 (Contrast Media)
RN  - 0 (Plasma Substitutes)
RN  - 0 (Triiodobenzoic Acids)
RN  - 451W47IQ8X (Sodium Chloride)
RN  - 8MDF5V39QO (Sodium Bicarbonate)
RN  - AYI8EX34EU (Creatinine)
RN  - N3RIB7X24K (ioversol)
RN  - WYQ7N0BPYC (Acetylcysteine)
SB  - IM
MH  - Acetylcysteine/*therapeutic use
MH  - Acute Kidney Injury/chemically induced/*prevention & control
MH  - Adult
MH  - Aged
MH  - Contrast Media/*adverse effects
MH  - Creatinine/blood
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Plasma Substitutes/administration & dosage
MH  - Renal Insufficiency/diagnosis
MH  - Sodium Bicarbonate/*administration & dosage
MH  - Sodium Chloride/administration & dosage
MH  - Triiodobenzoic Acids/adverse effects
EDAT- 2012/11/10 06:00
MHDA- 2014/01/23 06:00
CRDT- 2012/11/10 06:00
PHST- 2012/04/12 00:00 [received]
PHST- 2012/10/23 00:00 [accepted]
PHST- 2012/11/10 06:00 [entrez]
PHST- 2012/11/10 06:00 [pubmed]
PHST- 2014/01/23 06:00 [medline]
AID - 10.1007/s10157-012-0722-3 [doi]
PST - ppublish
SO  - Clin Exp Nephrol. 2013 Jun;17(3):396-404. doi: 10.1007/s10157-012-0722-3. Epub 
      2012 Nov 10.