The impact of N-acetylcysteine and ascorbic acid in contrast-induced nephropathy in critical care patients: an open-label randomized controlled study

• Published in: Critical care (London, England) England), 2017-10, Vol.21 (1), p.269-9, Article 269
• Main Authors: Palli, Eleni, Makris, Demosthenes, Papanikolaou, John, Garoufalis, Grigorios, Tsilioni, Irini, Zygoulis, Paris, Zakynthinos, Epaminondas
• Format: Article
• Language: English
• Subjects: 8-Isoprostane; Acetylcysteine; Acetylcysteine - pharmacology; Acetylcysteine - therapeutic use; Acute Kidney Injury - drug therapy; Acute Kidney Injury - etiology; Acute Kidney Injury - prevention & control; Administration, Intravenous; Analysis; Antibiotics; Antioxidants; Ascorbic acid; Ascorbic Acid - pharmacology; Ascorbic Acid - therapeutic use; Blood Urea Nitrogen; Contrast agents; Contrast induced nephropathy; Contrast Media - adverse effects; Creatinine - analysis; Creatinine - blood; Critical care; Critical Care - methods; Critically ill persons; cystatin-C; Diabetes; Dosage and administration; Female; Greece; Health aspects; Humans; Immunoassay; Intensive care; Intensive Care Units - organization & administration; Kidney - drug effects; Kidney - injuries; Kidney diseases; Kidneys; Male; Medical imaging; Middle Aged; Mortality; Multivariate Analysis; N-acetylcysteine; Neutrophils; Oxidative stress; Prospective Studies; Risk factors; ROC Curve; Statistics, Nonparametric; Tomography; Tomography, X-Ray Computed - adverse effects; Tomography, X-Ray Computed - methods; Vitamin C
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-017-1862-3

The aim was to investigate whether the use of N-acetylcysteine and ascorbic acid reduce contrast-induced nephropathy incidence in critical care patients. This was a one-center, two-arm, prospective, randomized, open-label, controlled trial in the Intensive Care Unit of the University Hospital of Larissa, Greece. Patients with stable renal function, who underwent non urgent contrast-enhanced computed tomography for diagnostic purposes, were included in the study. Patients in the treatment group (NacA, n = 60) received intravenously N-acetylcysteine (1200 mg) and ascorbic acid (2 g) dissolved separately in 100 ml of normal saline 2 hours before, and at 10 hours and 18 hours following the infusion of contrast agent, while control group patients (CG, n = 64) received only normal saline. All patients received additional hydration. Contrast-induced nephropathy was defined as relative increase by 25% of the baseline values of serum creatinine. Contrast-induced nephropathy in NacA and CG were 18.33% and 15.6%, respectively (p = 0.81). The percentage change median (interquartile range (IR)) of serum cystatin-C (mg/L) from baseline in patients who underwent contrast-induced tomography, were 37.23% (28.53) and 93.20% (46.90) in NacA and in CG, respectively (p = 0.03). The 8-isoprostane serum levels in NacA were significantly lower compared to CG at 2 hours (p = 0.012) and 24 hours (p = 0.006) following radiocontrast infusion. Multivariate analysis revealed that contrast-induced nephropathy was independently associated with a higher baseline ratio of serum urea/creatinine (odds ratio, 1.02; 95 CI%, 1.00-1.05) and with the use of nephrotoxic medications (odds ratio, 0.24; 95 CI%, 0.06-0.94). Intravenous administration of N-acetylcysteine and ascorbic acid failed to reduce contrast-induced nephropathy in critically ill patients who underwent contrast-enhanced computed tomography, despite a significant reduction of 8-isoprostane levels in treated patients. ClinicalTrials.gov, NCT01017796 . Registered on 20 November 2009.