Abbreviated Dosing of N‐Acetylcysteine Prevents Contrast‐Induced Nephropathy After Elective and Urgent Coronary Angiography and Intervention

Ochoa, Anthony; Pellizzon, Gregory G.; Addala, Srinivas; Grines, Cindy L.; Isayenko, Yelena; Boura, Judith; Rempinski, Debra; O’Neill, William W.; Kahn, Joel K.

doi:10.1111/j.1540-8183.2004.09880.x

Cited by 64 publications

(34 citation statements)

References 31 publications

(39 reference statements)

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“…30 Our study simultaneously compared multiple 35 36 treatment strategies using Bayesian network meta-analysis method, and found that 37 38 39 patients using CM were most likely to benefit from high-dose statin. The results of the 40 41 42 current study were similar to findings from previous primary studies [31][32][33][34] and meta- 43 44 45 analyses, 6,[35][36][37] which suggested that short-term prophylaxis with high-dose statins led 46 47 to a significant reduction in the risk of CI-AKI. In contrast, the meta-analysis by 1 Pre-existing renal dysfunction is an independent predictor of CI-AKI.…”

supporting

confidence: 80%

See 1 more Smart Citation

Comparative Effectiveness of 12 Treatment Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-analysis

Xie

Liu

et al. 2017

American Journal of Kidney Diseases

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supporting

confidence: 80%

“…Of the 11 previous meta-analyses 29 30 31 published on this subject, seven found a net benefit of NAC in CI-AKI prevention. 32 …”

Section: 6mentioning

confidence: 99%

Comparative Effectiveness of 12 Treatment Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-analysis

Xie

Liu

et al. 2017

American Journal of Kidney Diseases

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“…By contrast, in trials showing no effect of N-acetylcysteine, patients had had less severe renal insufficiency and a uniform 24-hour hydration protocol had been used (Table 6). In patients undergoing emergency diagnostic procedures, in whom a full hydration protocol is not possible, an abbreviated hydration regimen plus oral 90 or intravenous 91 administration of N-acetylcysteine was successful in reducing the rate of contrast-medium nephropathy. The development of contrast-medium nephropathy seems to depend on the amount of contrast agent given and on the dose of N-acetylcysteine.…”

Section: Low-dose Dopaminementioning

confidence: 99%

Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies

Goldenberg

Matetzky²

2005

Canadian Medical Association Journal

320

300

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WITH THE INCREASING USE OF CONTRAST MEDIA in diagnostic and interventional procedures, nephropathy induced by contrast media has become the third leading cause of hospital-acquired acute renal failure. It is also associated with a significant risk of morbidity and death. The current understanding of the pathogenesis indicates that contrast-medium nephropathy is caused by a combination of renal ischemia and direct toxic effects on renal tubular cells. Patients with pre-existing renal insufficiency, diabetes mellitus and congestive heart failure are at highest risk. Risk factors also include the type and amount of contrast medium administered. Therapeutic prevention strategies are being extensively investigated, but there is still no definitive answer. In this article, we review the current evidence on the causes, pathogenesis and clinical course of contrast-medium nephropathy as well as therapeutic approaches to its prevention evaluated in clinical trials.

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“…Duhram et al 17 found a CIN incidence of 26% when 1200 mg of NAC was administered before the administration of the contrast agent, and 1200 mg of NAC was given during the third hour after the administration of the contrast agent. Ochoa et al 18 reported that the incidence of CIN was 8% with NAC administered at similar dosages. In all three studies, which included mild-and low-risk patients, short-term NAC prophylaxis was used.…”

Section: Prepared (Preparation For Angiography Inmentioning

confidence: 98%

“…NAC was initiated within 1 hour before contrast administration and was given as a follow-up dose for 4 to 24 hours after the initial treatment. 17,18 Merten et al 19 compared sodium bicarbonate hydration with sodium chloride (NaCl) hydration in preventing CIN in azotemic patients. Sodium bicarbonate was initiated at 1 hour precontrast, with a follow-up dose 6 hours postcontrast.…”

mentioning

confidence: 99%

Comparison of Short‐term Infusion Regimens of N‐Acetylcysteine Plus Intravenous Fluids, Sodium Bicarbonate Plus Intravenous Fluids, and Intravenous Fluids Alone for Prevention of Contrast‐induced Nephropathy in the Emergency Department

Kama

Yılmaz

Yaka

et al. 2014

Academic Emergency Medicine

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BackgroundThere is no evidence regarding the several short‐term prophylaxis protocols for contrast‐induced nephropathy (CIN) that may be most feasibly convenient in emergency settings.ObjectivesThe purpose of this study was to compare the efficacies of short‐term CIN prophylaxis protocols of normal saline, N‐acetylcysteine (NAC) plus saline, and sodium bicarbonate plus saline in emergency department (ED) patients at moderate or high risk of CIN after receiving intravenous (IV) contrast agent.MethodsThis single‐center, randomized, nonblinded clinical trial was conducted in the ED with adult patients requiring contrast‐enhanced computed tomography (CT). Patients with moderate to high risk of CIN according to the Mehran risk score, who consented to participate, were eligible. Patients with continuous renal replacement therapy or who reported contrast allergy were excluded. Enrolled patients were randomly assigned to receive 150 mg/kg NAC in 1000 mL of 0.9% sodium chloride (NaCl), 150 mEq of sodium bicarbonate in 1000 mL of 0.9% NaCl, or 1000 mL of IV saline infusion, all given at 350 mL/hr for 3 hours. All of the patients were administered less than 100 mL of nonionic, low‐osmolality contrast agent. The primary outcome of CIN was defined as a 25% increase or a greater than 0.5 mg/dL increase in the serum creatinine level 48 to 72 hours later compared with the baseline measurement.ResultsA total of 107 patients were randomized to NAC (n = 36), sodium bicarbonate (n = 36), and saline prophylaxis (n = 35). The mean age of the patients was 71 years (95% confidence interval [CI] = 65 to 77 years), and 58 (54.2%) were male. The groups were similar regarding baseline characteristics and nephropathy risks. Of the 16 (14.9%) patients who eventually developed CIN, seven (19.4%) were in the NAC plus saline group, four (11.1%) were in the sodium bicarbonate plus saline group, and five (14.2%) were in the saline group. There were no significant differences between the groups in terms of the prevention of CIN (p = 0.60).ConclusionsNone of the short‐term protocols with normal saline, NAC, or sodium bicarbonate was superior in ED patients requiring contrast‐enhanced CT who had a moderate or high risk of CIN.

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Abbreviated Dosing of N‐Acetylcysteine Prevents Contrast‐Induced Nephropathy After Elective and Urgent Coronary Angiography and Intervention

Abstract: An abbreviated, higher dose regimen of NAC prevents the rise of serum creatinine 48 hours after cath/PCI, and may prevent CIN after cath/PCI.

Cited by 64 publications

References 31 publications

Comparative Effectiveness of 12 Treatment Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-analysis

Comparative Effectiveness of 12 Treatment Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-analysis

Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies

Comparison of Short‐term Infusion Regimens of N‐Acetylcysteine Plus Intravenous Fluids, Sodium Bicarbonate Plus Intravenous Fluids, and Intravenous Fluids Alone for Prevention of Contrast‐induced Nephropathy in the Emergency Department

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