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N-acetylcysteine does not prevent contrast induced nephropathy after cardiac catheterisation with an ionic low osmolality contrast medium: a multicentre clinical trial
  1. V O Gomes1,*,
  2. C E Poli de Figueredo2,
  3. P Caramori1,*,
  4. R Lasevitch1,
  5. L C Bodanese1,
  6. A Araújo1,
  7. A P Röedel3,
  8. A P Caramori3,
  9. F S Brito Jr4,**,
  10. H G Bezerra5,
  11. P Nery1,
  12. A Brizolara1
  1. 1Division of Interventional Cardiology, Hospital São Lucas, Pontifícia Universidade Católica-RS, Porto Alegre, Brazil
  2. 2Division of Nephrology, Hospital São Lucas, Pontifícia Universidade Católica-RS, Porto Alegre, Brazil
  3. 3Division of Cardiology, Hospital de Clínica, Porto Alegre, Brazil
  4. 4Division of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
  5. 5Division of Interventional Cardiology, Hospital São Camilo, São Paulo, Brazil
  1. Correspondence to:
    Dr Paulo Caramori
    Centre of Cardiovascular Research, Hospital São Lucas-PUCRS, Avenida Ipiranga 6690 room 300, 90610-000, Porto Alegre, RS, Brazil; caramori.pplug-in.com.br

Abstract

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
  • N-acetylcysteine
  • contrast media
  • prevention
  • contrast induced nephropathy
  • low osmolality contrast media
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Footnotes

  • * Also the Postgraduate Course of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

  • ** Also the Division of Interventional Cardiology, Hospital São Camilo, São Paulo

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