PREVENTION
OF RADIOGRAPHIC CONTRAST AGENT-INDUCED REDUCTIONS IN RENAL FUNCTION BY
ACETYLCYSTEINE.
Tepel
M, et al. N Engl J Med 2000 Jul
20;343(3):180-4.
BACKGROUND:
Radiographic contrast agents can cause a reduction in renal function that may
be due to reactive oxygen species. Whether the reduction can be prevented by
the administration of antioxidants is unknown.
METHODS:
We prospectively studied 83 patients with chronic renal insufficiency (mean
[+/-SD] serum creatinine concentration, 2.4+/-1.3 mg per deciliter [216+/-116
micromol per liter]) who were undergoing computed tomography with a nonionic,
low-osmolality contrast agent. Patients were randomly assigned either to
receive the antioxidant acetylcysteine (600 mg orally twice daily) and 0.45 percent
saline intravenously, before and after administration of the contrast agent, or
to receive placebo and saline.
RESULTS:
Ten of the 83 patients (12 percent) had an increase of at least 0.5 mg per
deciliter (44 micromol per liter) in the serum creatinine concentration 48
hours after administration of the contrast agent: 1 of the 41 patients in the
acetylcysteine group (2 percent) and 9 of the 42 patients in the control group
(21 percent; P=0.01; relative risk, 0.1; 95 percent confidence interval, 0.02
to 0.9). In the acetylcysteine group, the mean serum creatinine concentration
decreased significantly (P<0.001), from 2.5+/-1.3 to 2.1+/-1.3 mg per
deciliter (220+/-118 to 186+/-112 micromol per liter) 48 hours after the
administration of the contrast medium, whereas in the control group, the mean
serum creatinine concentration increased nonsignificantly (P=0.18), from
2.4+/-1.3 to 2.6+/-1.5 mg per deciliter (212+/-114 to 226+/-133 micromol per
liter) (P<0.001 for the comparison between groups).
CONCLUSIONS:
Prophylactic oral administration of the antioxidant acetylcysteine, along with
hydration, prevents the reduction in renal function induced by contrast agents
in patients with chronic renal insufficiency.