Does Oral N-Acetylcysteine Reduce Contrast-Induced Renal Injury in Patients With Peripheral Arterial Disease Undergoing Peripheral Angiography? A Randomized-Controlled Study
Available accessResearch articleFirst published online April, 2011
Does Oral N-Acetylcysteine Reduce Contrast-Induced Renal Injury in Patients With Peripheral Arterial Disease Undergoing Peripheral Angiography? A Randomized-Controlled Study
The nephroprotective role of N-acetylcysteine (NAC) against contrast-induced nephropathy (CIN) in patients undergoing peripheral arterial angiography remains unclear. A total of 40 patients undergoing peripheral arterial angiography were randomized to receive intravenous (iv) hydration only (group 1) or oral NAC in addition to iv hydration (group 2; ISRCTN: 35882618). Primary outcome was reduction in the elevation of urinary retinol binding protein (RBP), albumin—creatinine ratio (ACR), and serum creatinine (serC). Groups 1 and 2 had equivocal percentage reduction in RBP and ACR levels from baseline (P = .80 and .30). A significant reduction in serC was, however, observed with NAC by third postprocedure day (P = .04). One patient in the treatment arm developed CIN compared with 3 patients in the control group (P = .33). Equivocal changes in RBP and ACR levels by both treatments seem to indicate that either is equally effective in affording renal protection.
Barrett BJ, Parfrey PSPrevention of nephrotoxicity induced by radiocontrast agents. N Engl J Med. 1994;331(21):1449-1450.
2.
Kolonko A., Kokot F., Wiecek A.Contrast-associated nephropathy-old clinical problem and new therapeutic perspectives . Nephrol Dial Transplant. 1998 ;13(3):803-806.
3.
Tublin ME, Murphy ME, Tessler FNCurrent concepts in contrast media-induced nephropathy. AJR Am J Roentgenol. 1998;171(4): 933-939.
4.
Carbonell N. , Blasco M., Sanjuan R., et al. Intravenous N-acetylcysteine for preventing contrast-induced nephropathy: a randomised trial. Int J Cardiol . 2007;115(1):57-62.
5.
Tepel M., van der Giet M., Schwarzfeld C., Laufer U., Liermann D., Zidek W.Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med. 2000;343(3):180-184.
6.
Stenstrom DA , Muldoon LL, Armijo-Medina H., et al. N-Acetylcysteine use to prevent contrast medium-induced nephropathy: premature phase III trials. J Vasc Interv Radiol. 2008; 19(3):309-318.
7.
Rashid ST, Salman M., Myint F., et al. Prevention of contrast-induced nephropathy in vascular patients undergoing angiography: a randomized controlled trial of intravenous N-acetylcysteine . J Vasc Surg. 2004;40(6):1136-1141.
8.
Kotlyar E., Keogh AM, Thavapalachandran S., et al. Prehydration alone is sufficient to prevent contrast-induced nephropathy after day-only angiography procedures-a randomised controlled trial. Heart Lung Circ. 2005;14(4):245-251.
9.
Moore NN, Lapsley M., Norden AG, et al. Does N-acetylcysteine prevent contrast-induced nephropathy during endovascular AAA repair? A randomized controlled pilot study. J Endovasc Ther. 2006;13(5):660-666.
10.
Paraskevas KI, Giannoukas AD, Mikhailidis DPThe impact of impaired renal function on long-term outcomes in patients with peripheral arterial disease. Angiology . 2010;61(4):415-416.
11.
Paraskevas KI, Giannoukas AD, Mikhailidis DPRenal function impairment in peripheral arterial disease: an important parameter that should not be neglected. Ann Vasc Surg.2009; 23(5):690-699.
12.
O’Hare AM, Bertenthal D., Shlipak MG, Sen S., Chren MMImpact of renal insufficiency on mortality in advanced lower extremity peripheral arterial disease. J Am Soc Nephrol. 2005; 16(2):514-519.
13.
Bernard AM, Vyskocil AA, Mahieu P., Lauwerys RRAssessment of urinary retinol-binding protein as an index of proximal tubular injury. Clin Chem. 1987;33(6):775-779.
14.
Lapsley M., Akers K., Norden AGSensitive assays for urinary retinol-binding protein and beta-2-glycoprotein-1 based on commercially available standards. Ann Clin Biochem . 1998;35(pt 1): 115-119.
15.
McCullough PAContrast-induced acute kidney injury. J Am Coll Cardiol. 2008;51(15):1419-1428.
16.
Fung JW, Szeto CC, Chan WW, et al. Effect of N-acetylcysteine for prevention of contrast nephropathy in patients with moderate to severe renal insufficiency: a randomized trial . Am J Kidney Dis. 2004;43(5):801-808.
17.
Baskurt M., Okcun B., Abaci O., et al. N-acetylcysteine versus N-acetylcysteine + theophylline for the prevention of contrast nephropathy. Eur J Clin Invest.2009;39(9):793-799.
18.
Alnaeb ME, Youssef F., Mikhailidis DP, Hamilton G.Short-term lipid-lowering treatment with atorvastatin improves renal function but not renal blood flow indices in patients with peripheral arterial disease . Angiology. 2006;57(1):65-71.
19.
Vaidya VS, Waikar SS, Ferguson MA, et al. Urinary biomarkers for sensitive and specific detection of acute kidney injury in humans. Clin Transl Sci. 2008;1(3):200-208.
20.
Fliser D., Novak J., Thongboonkerd V., et al. Advances in urinary proteome analysis and biomarker discovery . J Am Soc Nephrol. 2007;18(4):1057-1071.
21.
Rifai N., Gillette MA, Carr SAProtein biomarker discovery and validation: the long and uncertain path to clinical utility. Nat Biotechnol. 2006;24(8):971-983.
22.
Hoffmann U. , Fischereder M., Kruger B., Drobnik W., Kramer BKThe value of N-acetylcysteine in the prevention of radiocontrast agent-induced nephropathy seems questionable. J Am Soc Nephrol. 2004 ;15(2):407-410.
23.
Morcos SKContrast-induced nephropathy: are there differences between low osmolar and iso-osmolar iodinated contrast media?Clin Radiol.2009;64(5):468-472.
24.
Al-Ghonaim M., Pannu N.Prevention and treatment of contrast-induced nephropathy. Tech Vasc Interv Radiol. 2006 ;9(2):42-49.
25.
Shyu KG, Cheng JJ, Kuan P.Acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure. J Am Coll Cardiol. 2002;40(8):1383-1388.
26.
Kay J., Chow WH, Chan TM, et al. Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and intervention: a randomized controlled trial. JAMA. 2003;289(5):553-558.
