Intravenous N -acetylcysteine plus high-dose hydration versus high-dose hydration and standard hydration for the prevention of contrast-induced nephropathy: CASIS—A multicenter prospective controlled trial

• Published in: International journal of cardiology 2012-03, Vol.155 (3), p.418-423
• Main Authors: Koc, Fatih, Ozdemir, Kurtulus, Kaya, Mehmet Gungor, Dogdu, Orhan, Vatankulu, Mehmet Akif, Ayhan, Selim, Erkorkmaz, Unal, Sonmez, Osman, Aygul, Meryem Ulku, Kalay, Nihat, Kayrak, Mehmet, Karabag, Turgut, Alihanoglu, Yusuf, Gunebakmaz, Ozgur
• Format: Article
• Language: English
• Subjects: Acetylcysteine - administration & dosage; Aged; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - methods; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Contrast induced nephropathy; Contrast Media - adverse effects; Coronary Angiography - adverse effects; Coronary Angiography - methods; Coronary Disease - diagnosis; Coronary Disease - therapy; Creatinine - blood; Dose-Response Relationship, Drug; Female; Fluid Therapy - methods; Follow-Up Studies; Free Radical Scavengers - administration & dosage; High-dose hydration; Humans; Infusions, Intravenous; Intravenous N-acetylcysteine; Kidney Diseases - blood; Kidney Diseases - chemically induced; Kidney Diseases - prevention & control; Male; Medical sciences; Middle Aged; Prospective Studies; Treatment Outcome
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2010.10.041

Abstract Background Contrast-induced nephropathy (CIN) is a leading cause of acute renal failure and affects mortality and morbidity. We investigated the efficacy of prophylactic intravenous (IV) N -acetylcysteine (NAC) and hydration for the prevention of CIN in patients with mild to moderate renal dysfunction who are undergoing coronary angiography and/or percutaneous coronary intervention (PCI). Methods A total of 220 patients who had mild to moderate renal dysfunction with serum creatinine (SCr) ≥ 1.1 mg/dL or creatinine clearance ≤ 60 mL/min were randomized in 3 groups: 80 patients were assigned to IV NAC plus high-dose hydration with normal saline, 80 patients to only high-dose hydration with normal saline and 60 patients to standard hydration with normal saline (control group). The primary end point was the alteration of SCr level. The secondary end point was the development of CIN after the procedure. Results SCr levels changed the least in the NAC plus high-hydration group ( P = 0.004). The rate of the CIN in the NAC plus high-dose hydration group was also lower than the high-dose hydration group ( P = 0.006). No significant differences in the primary and secondary end points were found between high-dose hydration and control group. Conclusion The results of this study suggest that NAC plus high-dose hydration was superior to high-dose hydration alone as well as standard hydration for the protection of renal functions in patients with mild to moderate renal dysfunction who are undergoing coronary angiography and/or PCI. High-dose hydration without NAC was not better than standard hydration alone.