别嘌呤醇联合水化对冠状动脉介入术后造影剂肾病预防作用的Meta分析

目的造影剂肾病是应用造影剂后引起的急性肾功能损伤,别嘌呤醇联合水化能否有效减少冠状动脉(冠脉)介入术后造影剂肾病的发生率。系统评价别嘌呤醇联合水化能否减少冠脉介入后造影剂肾病的发病率。方法计算机检索PubMed、EMbase、The Cochrane Library(2018年7期)、中国生物医学文献网、万方和中国知网等数据库,查找冠脉介入患者应用造影剂前采用别嘌呤醇联合水化预处理的随机对照试验(RCT),检索时限均从建库至2018年7月。由2位评价员按纳入与排除标准独立筛选文献、提取数据并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入5个RCT,包括699例患者,其中别嘌呤醇联合水化组349例,对照组单纯水化组350例。Meta分析结果显示:别嘌呤醇联合水化处理组造影剂肾病的发生率显著低于对照单纯水化组(RR=0.30,95%CI:0.10～0.88,P=0.03)。别嘌呤醇联合水化处理组术后肌酐、尿素氮和尿酸显著低于对照单纯水化组(SMD=-0.41,95%CI:-0.58～-0.25,P0.0001;SMD=-0.40,95%CI:-0.60～-0.20,P0.0001;SMD=-0.31,95%CI:-0.52～-0.11,P0.0001)。别嘌呤醇联合水化处理组肌酐清除率显著高于对照单纯水化组(SMD=0.48,95%CI:0.21～0.75,P=0.0005)。结论别嘌呤醇联合水化处理较单纯水化显著减少造影剂肾病的发生率,并且减少肾功能不全患者应用造影剂后肾功能的损伤。受纳入研究数量和质量限制,上述结论仍需开展更多高质量的RCT加以验证。     

阿托伐他汀联合水化治疗在造影剂肾病低风险人群中的预防作用

【】 目的 评价阿托伐他汀联合水化治疗在造影剂肾病低风险人群中的预防作用。方法 选择124例行冠心病介入治疗患者为研究对象,随机分为对照组和试验组。试验组在术前12h以及术后12h给予水化治疗,并于术前72小时每晚服用阿托伐他汀40mg至术后48小时,对照组不予水化以及阿托伐他汀口服。观察患者手术前24h以及术后48h血肌酐水平、肾小球滤过率以及造影剂肾病发病率。结果 术后试验组血肌酐水平低于对照组,肌酐清除率水平高于对照组,同时试验组造影剂肾病发病率低于对照组,两组具有统计学意义(P＜0.05)。结论：对于发生造影剂肾病较低风险的人群在行介入治疗手术期间予水化联合应用阿托伐他汀同样具有降低造影剂肾病发生风险。     

水化对冠状动脉造影患者造影剂肾病的影响

目的观察水化对冠状动脉造影患者肾功能的影响及造影剂肾病的发生率。方法应用低渗非离子型造影剂碘海醇进行冠状动脉造影,将216例行冠状动脉造影或冠状动脉介入治疗患者随机分为两组:水化组112例,在常规补液基础上进行水化治疗;对照组104例,常规补液治疗,比较两组在造影前及造影后48 h、1周时血清肌酐、尿β2微球蛋白的浓度变化,观察两组造影剂肾病的发生率。结果水化组和对照组在造影后48 h血清肌酐、尿β2微球蛋白均升高,以对照组升高更显著。造影后1周两组均下降。水化组造影剂肾病发生率为4%,对照组为17%。结论加强水化能减轻肾功能伤害,减少造影剂肾病的发生率。     

左卡尼汀对冠心病合并糖尿病患者介入治疗术后发生对比剂肾病的临床疗效观察

目的:探讨在常规水化治疗的基础上加用左卡尼汀(L-carnitine)能否更有效地减少冠心病合并糖尿病高危患者经皮冠状动脉介入治疗(PCI)术后对比剂肾病(CIN)的发生率,并观察其临床疗效。方法:连续入选145例冠心病合并糖尿病的患者,随机分为两组。对照组(73例):仅用0.9%氯化钠溶液进行常规水化;治疗组(72例):在上述对照组的基础上,于术前三天及术后连续三天予以左卡尼汀注射液3.0 g静脉输注。所有入选患者分别于术前、术后24 h及48 h测定血清肌酐。留取尿液标本检测尿肾损伤分子1(KIM-1)。根据肾脏病饮食调整研究公式计算估测肾小球滤过率(eGFR)。比较两组患者对比剂肾病的发生率,观察术后患者的血肌酐(Scr)、尿KIM-1浓度变化及心血管不良事件发生情况。结果:145例患者中19例(13.1%泼生对比剂肾病,其中对照组14例(19.2%)发生对比剂肾病,治疗组5例(6.9%)发生对比剂肾病,治疗组与对照组比较,对比剂肾病的发生率差异有统计学意义(P0.05)。两组患者血肌酐、估算的肾小球滤过率及尿肾损伤分子1变化显示,与对照组比较,治疗组术后24 h、48 h血肌酐降低、估算的肾小球滤过率升高及尿肾损伤分子1降低,差异均有统计学意义(P均0.05)。所有患者均未出现严重的心血管不良事件。结论:对于冠心病合并糖尿病的患者短期应用左卡尼汀注射液可降低对比剂肾病的发生率。     

左卡尼汀对于冠状动脉介入治疗后对比剂肾病的影响

目的:探讨左卡尼汀对于冠状动脉(冠脉)介入治疗(PCI)后对比剂肾病(CIN)的影响。方法:将我院行PCI的冠心病患者138例随机分为左卡尼汀组和非左卡尼汀组,每组69例。两组在水化治疗基础上,左卡尼汀组在术前24 h,术后每日1次静脉输注左卡尼汀2 g,共使用4天。然后分别测定并比较两组患者造影后24 h、72 h的血清尿素氮(BUN)、血清肌酐(Scr)、内生肌酐清除率(Ccr)以及CIN的发生率。对比剂全部使用非离子型低渗对比剂碘普罗胺(优维显),记录术中使用剂量。结果:左卡尼汀组术后24 h、72 h BUN及Scr明显低于非左卡尼汀组(P均0.05),Ccr术后24 h、72 h高于非左卡尼汀组(P均0.05),差异均有统计学意义。CIN的发生率左卡尼汀组(5.80%vs 15.94%)明显低于非左卡尼汀组(P0.05)。结论:应用左卡尼汀对于PCI患者CIN的发生具有一定的预防保护作用。     

达格列净对冠心病合并2型糖尿病患者PCI后肾功能及造影剂肾病的影响

目的 探讨达格列净对冠心病合并2型糖尿病患者PCI后肾功能及造影剂肾病（CIN）的影响。方法选取2021年于河北医科大学第二医院心内科行择期PCI的冠心病合并2型糖尿病患者59例，按照随机数字表法将患者分为研究组（n=36）和对照组（n=23）。研究组采用标准冠心病治疗方案联合达格列净治疗，对照组采用标准冠心病治疗方案联合阿卡波糖治疗。比较两组术后48 h CIN发生率、基线资料、术前和术后48 h肾功能指标[血肌酐（Scr）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、胱抑素C(Cys-C)、估算肾小球滤过率（eGFR）]。采用多因素Logistic回归分析探讨达格列净对冠心病合并2型糖尿病患者PCI后发生CIN的影响。观察患者住院期间严重不良事件、达格列净或阿卡波糖相关不良反应、急性肾损伤发生情况。结果 研究组CIN发生率为5.6%(2/36)，对照组CIN发生率为13.0%(3/23)。两组CIN发生率比较，差异无统计学意义（P>0.05）。两组术后48 h Scr、NGAL、Cys-C分别高于本组术前，eGFR分别低于本组术前，且研究组术前与术后48 h Scr、NGA...     

老年糖尿病患者冠脉介入治疗术后对比剂肾病的防治

目的探讨老年糖尿病患者预防对比剂肾病(CIN)的方法。方法共入选256例接受冠脉介入治疗的老年糖尿病患者,根据所用对比剂的种类及接受水化治疗与否分为碘普罗胺组(n=85),碘普罗胺联合水化治疗组(n=87)和碘克沙醇组(n=84)。所有入选患者均于术前及术后第3日检测血肌酐水平,观察患者手术前后血肌酐水平的变化情况,研究的主要终点为3组患者术后CIN的发生率。结果 3组患者的术前血肌酐水平、肌酐清除率及术中对比剂用量无明显差异,术后碘普罗胺组、碘普罗胺联合水化治疗组以及碘克沙醇组CIN的发生率分别为18.8%,8.0%和13.1%。联合水化治疗组CIN的发生率明显低于碘普罗胺组患者(P=0.038),而碘克沙醇组与碘普罗胺组间CIN的发生率差异无统计学意义。结论相比于单纯应用等渗对比剂,联合水化治疗在降低老年糖尿病患者CIN发生率方面发挥更重要的作用。因此,对于拟行冠脉介入治疗的老年糖尿病患者,手术前后应进行水化治疗以减少CIN的发生。     

肾阻力指数指导下的水化治疗预防造影剂肾病的临床研究

目的:探讨冠心病合并慢性肾功能不全患者水化治疗的方案。方法:选择冠心病合并慢性肾功能不全拟行冠状动脉造影术的患者286例,随机分为标准水化组(143例,50%)和肾阻力指数指导下的水化组(143例,50%),观察围手术期心肾功能的主要指标变化及3个月主要不良事件发生率。结果:肾阻力指数指导下水化治疗组水化液体量高于对照组(P0.05),造影剂肾病、血液透析、全因死亡的发生率低于对照组(P0.05)。结论:肾阻力指数指导下的水化治疗能够有效减少冠心病合并慢性肾功能不全患者造影剂肾病的发生。     

维生素C预防老年肾功能不全患者造影剂性肾病的临床疗效

目的探讨对拟行冠状动脉造影的老年基础肾功能不全患者应用维生素C预防造影剂性肾病的安全性和临床疗效。方法本研究为单中心前瞻性随机对照临床试验,连续入选132例血清肌酐≥11mg/L(97.2μmol/L)拟行冠状动脉造影的老年患者,随机分为两组。干预组(n=70)在水化基础上于造影前经静脉予维生素C3g及造影后口服维生素C0.5g2次/d,连服2d;对照组(n=62)仅生理盐水水化;所有患者均于术前及术后接受常规水化,观察术后患者的肾功能及心血管事件。结果维生素C干预组与对照组,在主要终点指标即术后48h内血清肌酐峰值变化上,两组之间无显著性差异(0.2±1.7)vs(0.3±2.2)mg/L,P=0.625;在次要终点即造影剂性肾病的发病率上,维生素C干预组较对照组低,但无显著性差异(5.6%vs8.1%,P=0.594)。两组患者在院内临床预后及住院时间上无明显差异。结论对于行冠脉造影的老年基础肾功能不全患者短程应用大剂量维生素C有降低造影剂性肾病发生的趋势。     

糖尿病合并冠心病冠脉介入后造影剂肾病相关因素的研究

目的研究糖尿病合并冠心病患者经皮冠状动脉介入治疗(PCI)治疗后发生造影剂肾病(CIN)的危险因素。方法在广东省人民医院选取2008年11月至2009年12月糖尿病合并冠心病患者行PCI患者383例。根据术后血清肌酐变化情况分为两组,即造影剂肾病组(CIN组)60例,非造影剂肾病组(非CIN组)323例,回顾性调查分析两组患者的临床资料,应用Logistic回归分析发生造影剂肾病的危险因素。结果 383例患有糖尿病合并冠心病并行PCI术患者中,术后有60例发生CIN,CIN的发生率为15.67%;应用Logistic回归分析发现术后发生CIN的危险因素为肾功能不全(P<0.01,OR=6.033)、手术前后使用速尿(P<0.01,OR=4.443)和高血压(P=0.001,OR=3.693)。结论肾功能不全,手术前后使用速尿和高血压是糖尿病合并冠心病患者PCI治疗后发生造影剂肾病的危险因素。在进行PCI治疗前后应进行充分的水化治疗并且做好预防护理措施。     

重组人脑利钠肽对慢性肾脏病患者行PCI后造影剂肾病的预防价值

目的:探讨重组人脑利钠肽对慢性肾脏病(CKD)患者行冠状动脉介入(PCI)治疗后造影剂肾病(CIN)的预防作用.方法:选择我科2017年1月-2021年1月行PCI治疗的CKD患者108例,随机分为重组人脑利钠肽组(52例)和对照组(56例),重组人脑利钠肽组在行PCI前12h给予重组人脑利钠肽0.005 μg·kg-...     

在使用强化瑞舒伐他汀情况下水化治疗预防冠心病介入诊治后对比剂肾病的疗效

目的:观察在使用强化瑞舒伐他汀情况下静脉水化治疗对预防冠心病介入诊治后对比剂肾病的疗效。方法:选择冠心病介入诊治患者210例,强化瑞舒伐他汀并水化治疗组(水化治疗组)108例(术前及术后1周内应用瑞舒伐他汀20 mg/d,1周后减量为10 mg/d,同时于术前及术后6 h给予生理盐水静脉水化治疗);对照组102例(术前及术后1周内应用瑞舒伐他20 mg/d,1周后减量为10 mg/d)。观察介入诊治后1周内对比剂肾病的发生率、肌酐、肌酐清除率以及高敏C反应蛋白(hsCRP)含量的变化。结果:术后1 d两组血肌酐水平都较术前明显升高(P0.05,P0.01),与对照组相比,水化治疗组于术后2 d血肌酐已降至术前水平;于术后1周,两组血肌酐恢复至术前水平。同样,两组患者血肌酐清除率在术后均下降,最低在术后1 d,后逐渐恢复。水化治疗组血肌酐清除率在术后2 d已经恢复至术前水平,而对照组仍明显低于术前水平(P0.05),于术后1周恢复至术前水平。水化治疗组对比剂肾病的发生率为5.6%,而对照组对比剂肾病的发生率为12.7%。两组患者术后1 d血浆hsCRP的含量与术前相比均明显升高,水化治疗组于术后2 d显著低于对照组(P0.05);于术后1周两组间无显著差异。结论:静脉水化治疗联合强化瑞舒伐他汀治疗可明显降低冠心病介入诊治后对比剂肾病的发生率。     

水化和他汀类药物预防对比剂肾病的临床观察

目的探讨他汀类药物在预防对比剂肾病(contras-t induced nephropathy,CIN)中的作用。方法选择行经皮冠状动脉造影病人115例,采用随机数字表法将病人分为他汀组(n=40)、水化组(n=34)以及对照组(n=41)。他汀组于冠状动脉造影术前3d开始每晚顿服阿托伐他汀20mg,水化组予0.9%氯化钠注射液静脉滴注,速度为1ml/(kg.h),一般于术前4h开始至术后12h结束,对照组未服用阿托伐他汀及其他调脂类药物亦未应用水化处理。观察患者术前1d、术后36～48h血清肌酐(Scr)、内生肌酐清除率(Ccr)、尿白蛋白肌酐比(UACR)以及超敏C反应蛋白(hsCRP)的改变情况。结果他汀组及对照组两组患者术后血hsCRP、Scr,UACR较术前均升高(均P<0.05),而血Ccr较术前降低(P<0.05)。对照组患者术后血hsCRP、UACR较他汀组术后明显升高(P<0.05),对照组对比剂肾病发生率(9.76%)高于他汀组(5.00%)。水化组术后血hsCRP、Scr、UACR及血Ccr与术前相比差异无统计学意义,对比剂肾病发生率明显小于他汀组及对照组。结论造影剂可造成轻微的肾功能损害;术前3d使用他汀药物,可能具有减轻炎症反应、预防造影剂肾病发生的作用,但相比之下水化处理更能明显减少对比剂肾病的发生。     

冠心病患者冠脉介入治疗术后对比剂肾病的相关因素和尿NGAL对对比剂肾病的早期诊断价值

目的 探讨尿中性粒细胞明胶酶相关载脂蛋白（NGAL）对冠心病患者经皮冠脉介入（PCI）治疗术后对比剂肾病（CIN）的早期诊断意义以及CIN的相关因素。 方法 选取入院后行PCI的冠心病患者208例，其中并发高血压病118例、并发糖尿病106例、并发慢性心力衰竭28例、慢性肾功能不全24例，检测术前及术后4、24、48和72 h血清肌酐（SCr）、尿NGAL的含量，对CIN进行诊断性评价。观察CIN的发生率，同时观察住院至出院1个月内的主要心血管不良事件（MACE）。 结果 208例患者中术后发生CIN31例，CIN发生率为14.9%；CIN组糖尿病和慢性心力衰竭的患病率以及MACE发生率显著高于非CIN组（P<0.05）。CIN组和非CIN组术前尿NGAL含量水平相似，两组比较无统计学意义，CIN组术后4 h尿NGAL开始升高，且逐渐升高至72 h，与术前比较有统计学意义（P<0.05）；非CIN组术后尿NGAL较术前升高不明显；两组术后同时段尿NGAL的含量比较具有统计学意义（P<0.05）。ROC曲线分析发现，术后尿NGAL各时段4、24、48和72 h的曲线下面积（AUC）分别为0.932、0.946、0.957和0.975，诊断的敏感性为94%，特异性为100%；术后SCr各时段相应的AUC分别为0.588、0.562、0.842和0.879，诊断CIN的敏感性、特异性明显低于尿NGAL。Logistic多因素回归分析显示:糖尿病、SCr、肾小球滤过率估算值（eGFR）[<60 ml/(min·1.73 m2)]、NGAL、慢性心力衰竭[左室射血分数（LVEF）<35%]、糖化血红蛋白(>9.5%)是CIN的危险因素。 结论 尿NGAL对PCI治疗术后CIN具有一定的早期诊断价值。并发糖尿病、慢性肾功能不全、慢性心力衰竭等为CIN的相关因素。发生CIN后MACE明显增高。      

ACEI/ARB与CCB防治高血压病伴慢性肾功能不全患者发生造影剂肾病的效果比较

目的 比较血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体阻断剂(ARB)和钙离子通道阻断剂(CCB)对高血压病伴慢性肾功能不全（CKD）患者在介入术后发生造影剂肾病(CIN)的防治效果。方法 回顾分析近6年南方医院内科病房180例高血压病伴CKD 2~3期患者,所有患者均接受了冠脉介入术,并在术前术后使用了水化治疗,术前至少使用了7 d的ACEI/ARB或CCB药物,另设单纯水化对照组;观察3组患者发生CIN的例数,以及术后24、48、72 h及 7d的血清肌酐（SCr）、肌酐清除率（CCr）的变化水平,并记录肾功能恢复的时间。结果 ACEI/ARB组术后发生CIN 20例（占37%),CCB组术后发生CIN 16例（占20%),单纯水化组发生28例(占61%);与单纯水化组比较,两组术后CIN发生率均较低（P<0.05,P<0.01）;CCB组和ACEI/ARB组比较,CCB组的CIN发生率较低（P<0.05）。3组患者介入术后24、48、72 h及7 d的SCr、CCr水平均有明显升高,差异有显著性;与单纯水化组相比,ACEI/ARB组和CCB组的血清SCr、CCr水平在24、48、72 h及7 d的时间点均有所降低,差异有显著性;CCB组与ACEI/ARB组相比,48、72 h及7 d的SCr降低较明显（均P<0.05）。术后14 d,ACEI/ARB组有14例（占70%）CIN患者肾功能恢复至术前水平,CCB组有12例（占75%）,单纯水化组有16例（占62%）,ACEI/ARB组和CCB比较差异无统计学意义。结论 使用ACEI/ARB 和CCB类药物均可对高血压病并发CKD患者发生CIN有预防作用;CCB类药物优于ACEI/ARB类药物。     

Cardiovascular and renal toxicity of a nonionic radiographic contrast agent after cardiac catheterization. A prospective trial

STUDY OBJECTIVE: To determine the incidence of cardiovascular and renal toxicity of a nonionic contrast agent when used for cardiac catheterization, and to assess the value of electrolytes and urinalysis results as predictors of nephropathy induced by a contrast agent. STUDY DESIGN: Nonrandomized trial using a criterion standard and a cohort analytic study with a 48-hour follow-up. SETTING: Referral-based university hospital. PATIENTS: Convenience sample of patients having diagnostic cardiac catheterization. Renal function and clinical status were evaluated at baseline in 1,144 patients; at 24 hours in 1,077 (94%); and at 48 hours in 663 (57%). INTERVENTIONS: After patients received saline for hydration, coronary angiography and left ventriculography were done with iopamidol (average dose, 203 +/- 56 cc). MEASUREMENTS AND MAIN RESULTS: The definite and possible incidence of major acute cardiovascular complications from nonionic contrast media was 0.2% and 0.7%, respectively. The mean serum creatinine level increased 11.5 mumol/L from baseline at 24 hours (P less than 0.0001) and 16.8 mumol/L from baseline at 48 hours (P less than 0.0001). Results in a randomly selected training sample were studied to determine predictors of a rise in serum creatinine of 44.2 mumol/L or more. The baseline serum creatinine level and age were significant predictors of renal injury, but hypertension, diabetes mellitus, congestive heart failure, vascular disease, the volume of contrast agent injected or baseline values of urinary variables did not predict nephrotoxicity. In an independent validation sample, only the baseline serum creatinine level was confirmed as a predictor of nephrotoxicity, whereas age was not. A model that predicted contrast-induced nephropathy by the serum creatinine level showed an exponential increase in the risk for nephrotoxicity if the baseline level was 106.1 mumol/L or higher. CONCLUSIONS: Patients have a small but significant rise in serum creatinine after cardiac catheterization with a nonionic contrast agent. Baseline renal insufficiency is the only confirmed predictor of nonionic contrast-induced nephrotoxicity.     

Comparing Trimetazidine with Allopurinol in Prevention of Contrast Induced Nephropathy After Coronary Angiography

ObjectivesContrast-induced nephropathy is considered a serious complication following coronary angiography increasing morbidity and mortality. Various drugs have been assessed to reduce the incidence of contrast-induced nephropathy. In this study, we compared trimetazidine and allopurinol as a pharmacological measure to reduce the incidence of contrast-induced nephropathy.MethodsOne hundred and twenty patients undergoing coronary angiography with baseline creatinine clearance more than 30 ml/minute were divided into three groups, 40 patients each. Group 1 received standard parenteral intravenous hydration in the form of isotonic saline at a rate of 1 ml/kg body weight per hour started 12 hours before angiography and up to 12 hours after the procedure. Group 2 received trimetazidine 35 mg twice per day for 72 hours starting 48 hours before the procedure in addition to intravenous hydration. Group 3 received allopurinol 300 mg once daily for 72 hours starting 48 hours before the procedure in addition to intravenous hydration. Serum creatinine and creatinine clearance were measured before and 72 hours after the procedure in addition to the volume of contrast media used.ResultsTrimetazidine and allopurinol failed to reduce contrast-induced nephropathy significantly. Among patients with contrast-induced nephropathy volume of contrast media was significantly higher.ConclusionAdding trimetazidine or allopurinol in addition to regular intravenous hydration with isotonic saline without targeting selectively high-risk patients did not reduce contrast-induced nephropathy following coronary angiography     

Oral acetylcysteine as an adjunct to saline hydration for the prevention of contrast-induced nephropathy following coronary angiography. A randomized controlled trial and review of the current literature.

AIMS: To determine laboratory and clinical benefit of oral acetylcysteine, as an adjunct to saline hydration, in chronic renal insufficiency patients undergoing coronary angiography. METHODS AND RESULTS: We prospectively studied 80 patients with chronic renal insufficiency (mean [+/-SD] serum creatinine concentration 2.0+/-0.39mg/dl), who underwent coronary angiography with or without intervention. Patients were randomly assigned to receive either acetylcysteine (600mg orally t.i.d.) or placebo, in addition to intravenous 0.45% saline (1ml/kg of body weight per hour), 12h prior to and after coronary angiography. There was an increase of >/=0.5mg/dl in the serum creatinine concentration 48h after coronary angiography in seven of the 80 patients (9%): in four of the 41 patients (10%) in the acetylcysteine group and in three of the 39 patients (8%) in the placebo group (P=0.52). The incidence of in-hospital adverse clinical events (acetylcysteine, 5% vs placebo, 8%, P=0.47) and the length of hospital stay [acetylcysteine, median (interquartile range) 4 (2-4) days vs placebo, 2 (2-4) days, P=0.44] did not differ significantly between the two treatment groups. CONCLUSION: Our findings do not support routine prophylactic administration of oral acetylcysteine as an adjunct to saline hydration for the prevention of contrast-induced nephropathy in chronic renal insufficiency patients undergoing coronary angiography.     

Efficacy of N-acetylcysteine and hydration versus placebo and hydration in decreasing contrast-induced renal dysfunction in patients undergoing coronary angiography with or without concomitant percutaneous coronary intervention

OBJECTIVE: Contrast-induced renal dysfunction is an iatrogenic complication that occurs more frequently in patients with preexisting renal dysfunction. A prospective, double-blind, randomized, placebo, controlled trial was completed to assess the efficacy of N-acetylcysteine in decreasing the incidence of contrast-induced renal dysfunction in patients with an acute coronary syndrome and renal insufficiency who underwent coronary angiography with or without percutaneous coronary intervention. METHODS: With similar intravenous hydration protocols, 20 patients received N-acetylcysteine (treatment group) and 20 patients received placebo (control group) in a twice per day dosing regimen with one dose before and three doses after contrast media exposure. RESULTS: The two groups were similar at baseline on demographic and clinical characteristics, and preexisting renal insufficiency. Contrast-induced renal dysfunction, defined as an increase in serum creatinine greater than 44 micromol/L (.5 mg/dL) and/or 25% above baseline within 48 hours, occurred in 7.5% of the cohort, with 2.5% in the treatment group, and 5% in the control group, for an absolute difference of 2.5%. There was no difference in serum creatinine or creatinine clearance at 24 hours or at 48 hours between the treatment and control groups. CONCLUSION: These results suggest that this cohort gained no added protection to renal function with the use of N-acetylcysteine.