Intrarenal application of N-acetylcysteine for the prevention of contrast medium-induced nephropathy in primary angioplasty

Aslanger, Emre; Uslu, Bora; Akdeni̇z, Celal; Polat, Nihat; Cizgici, Yaşar; Oflaz, Hüseyin

doi:10.1097/mca.0b013e328351aacc

Cited by 32 publications

(19 citation statements)

References 13 publications

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“…Six of the included studies evaluated the effect of NAC in the prevention of CIN. [7][8][9][10][11][12] The administration form and doses of NAC varied among the studies. Three studies evaluated a high dose of NAC equivalent to an IV bolus of 1,200 mg before the primary PCI and 1,200 mg NAC IV twice daily for 48 hours after the procedure 9,10 or 200 mg/hr for 24 hours.…”

Section: Resultsmentioning

confidence: 99%

“…After the procedure both groups received additional 1,200 mg of NAC orally twice daily for 48 hours. 11 Finally, a study administered a low dose equivalent to 705 mg NAC orally before the procedure and 12, 24, and 36 hours after the procedure. 7 All the included studies with NAC used an additional hydration protocol ( Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…7 All the included studies with NAC used an additional hydration protocol ( Table 1). Five of the 6 included studies did not show any effect of NAC on the incidence of CIN, serum creatinine level, serum cystatin C level, creatinine clearance, clinical outcomes or mortality 7,[9][10][11][12] (see Table 1). One study showed an effect of both high dose and low dose NAC in reducing the occurrence of CIN as compared with placebo.…”

Section: Resultsmentioning

confidence: 99%

“…21 However, a high dose of NAC was additionally evaluated in 4 of the included studies without showing any effect on the incidence of CIN when compared with placebo. [9][10][11][12] The results observed in patients with STEMI and treated with primary PCI reflect the overall heterogeneity across NAC studies. NAC has been investigated in many randomized clinical trials and subsequent meta analyses and no consistent answer of the effectiveness of NAC in the prevention of CIN has been found.…”

Section: Discussionmentioning

confidence: 99%

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Prevention of Contrast‐Induced Nephropathy in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review

Busch

Jensen

Rosenberg

et al. 2012

J Interven Cardiology

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Objective:To evaluate the current prophylactic strategies against CIN in patients with STEMI treated by primary percutaneous coronary intervention. Background: Contrast-induced nephropathy (CIN) is the third leading course of acute renal failure and a recognized complication to cardiac catheterization. CIN is associated with increased risk of cardiac adverse events and mortality, and recent studies point at the risk of developing a transient or persistent renal dysfunction. Patients with ST-elevation myocardial infarction treated by primary percutaneous coronary intervention have a markedly increased risk of developing CIN. At present no strategy is universally accepted in the prevention of CIN in the acute setting of primary percutaneous coronary intervention. Method: We performed a systematic search in Pubmed and EMBASE and ended up including nine randomised clinical trials; six studies of N-acetylcysteine, one study of early and late hydration regimens, one study of recombinant human brain natriuretic peptide and one study comparing a low-osmolar contrast agent with an iso-osmolar contrast agent. Results: Recombinant human brain natriuretic peptide and the regimens of hydration significantly reduced the incidence of CIN and administration of N-acetylcysteine in one of the six studies significantly reduced the occurrence of CIN. The iso-osmolar contrast agent was not proven to be superior to the low-osmolar contrast agent in terms of preventing CIN. Conclusion: Preliminary studies are promising but further studies are needed before any prevention strategy against CIN can be recommended in routine care of patients undergoing primary percutaneous coronary intervention for STEMI. (J Interven Cardiol 2013;26:97-105) Address for reprints: Sarah Busch, Ved Kløvermarken 9, 2.th, events, prolonged hospitalization, and short-and longterm mortality. 1-3 Patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) have an increased risk of developing CIN when compared with patients undergoing elective PCI. 4,5 Conditions such as hemodynamic instability and impaired systemic perfusion caused by left ventricular dysfunction, large volume of contrast medium, renal hypotension and lack of hydration or other effective prophylactic measures may contribute to the development of renal dysfunction. 4,5 CIN was previously considered a reversible form of acute kidney injury. However, a recent study showed An increase in serum cystatin C concentration of >25% from baseline within 72 hours after PCI.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Prevention of Contrast‐Induced Nephropathy in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review

Busch

Jensen

Rosenberg

et al. 2012

J Interven Cardiology

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“…Since vasoconstriction is believed to be a pathogenic factor in contrast-induced nephropathy, vasodilatory effects may prove helpful and NAC has been the subject of numerous trials with mixed results [ 317 – 320 ]. The great difference in the clinical trials is the degree of risk of the patients involved.…”

Section: Conventional Drugs With Antioxidant “Side Effects”mentioning

confidence: 99%

Mitochondria: a new therapeutic target in chronic kidney disease

et al. 2015

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Cellular metabolic changes during chronic kidney disease (CKD) may induce higher production of oxygen radicals that play a significant role in the progression of renal damage and in the onset of important comorbidities. This condition seems to be in part related to dysfunctional mitochondria that cause an increased electron “leakage” from the respiratory chain during oxidative phosphorylation with a consequent generation of reactive oxygen species (ROS).ROS are highly active molecules that may oxidize proteins, lipids and nucleic acids with a consequent damage of cells and tissues.To mitigate this mitochondria-related functional impairment, a variety of agents (including endogenous and food derived antioxidants, natural plants extracts, mitochondria-targeted molecules) combined with conventional therapies could be employed.However, although the anti-oxidant properties of these substances are well known, their use in clinical practice has been only partially investigated. Additionally, for their correct utilization is extremely important to understand their effects, to identify the correct target of intervention and to minimize adverse effects.Therefore, in this manuscript, we reviewed the characteristics of the available mitochondria-targeted anti-oxidant compounds that could be employed routinely in our nephrology, internal medicine and renal transplant centers. Nevertheless, large clinical trials are needed to provide more definitive information about their use and to assess their overall efficacy or toxicity.

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Meta-analytic Techniques to Assess the Association Between N-acetylcysteine and Acute Kidney Injury After Contrast Administration

Ilin

Clark

et al. 2022

JAMA Netw Open

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Intrarenal application of N-acetylcysteine for the prevention of contrast medium-induced nephropathy in primary angioplasty

Cited by 32 publications

References 13 publications

Prevention of Contrast‐Induced Nephropathy in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review

Prevention of Contrast‐Induced Nephropathy in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review

Mitochondria: a new therapeutic target in chronic kidney disease

Meta-analytic Techniques to Assess the Association Between N-acetylcysteine and Acute Kidney Injury After Contrast Administration

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