Objective: To evaluate oral N-acetylcysteine in the prevention of contrast induced nephropathy (CIN) in patients at low to moderate risk undergoing cardiac catheterisation with ionic low osmolality contrast medium.
Methods: In a multicentre double blind clinical trial 156 patients undergoing coronary angiography or percutaneous coronary intervention with serum creatinine ⩾ 106.08 μmol/l or creatinine clearance < 50 ml/min or diabetes mellitus were randomly assigned to receive N-acetylcysteine 600 mg orally twice daily for two days or placebo. Only low osmolality ionic contrast medium was used.
Results: Sixteen patients developed CIN, defined as an increase of 44.2 μmol/l in creatinine in 48 hours: eight of 77 patients (10.4%) in the N-acetylcysteine group and eight of 79 patients (10.1%) in the placebo group (p = 1.00). The mean (SD) change in serum creatinine was similar in both groups: 7.96 (35.36) μmol/l in the N-acetylcysteine group and 6.19 (25.64) μmol/l in the placebo group (p = 0.67). No difference was observed in the change in endogenous creatinine clearance (−0.54 (10.4) ml/min v –2.52 (12.3) ml/min, N-acetylcysteine and placebo, respectively, p = 0.28).
Conclusion: Oral N-acetylcysteine did not prevent CIN in patients at low to moderate risk undergoing cardiac catheterisation with ionic low osmolality contrast medium.
- CI, confidence interval
- CIN, contrast induced nephropathy
- CrCl, creatinine clearance
- PCI, percutaneous coronary intervention
- contrast media
- contrast induced nephropathy
- low osmolality contrast media
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