N-acetylcysteine for the prevention of contrast-induced nephropathy in the emergency department

Teh Fu Hsu, Ming Kun Huang, Shao Hua Yu, David Hung Tsang Yen, Wei Fong Kao, Ying Chou Chen, Mu Shun Huang

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Abstract

Objective To evaluate the use of N-acetylcysteine (NAC), a potent antioxidant, to prevent contrast-induced nephropathy (CIN). Methods We prospectively studied 209 patients (106 in the NAC group and 103 in the control group) who received contrast-enhanced computed tomography (CECT) in the emergency department (ED). The NAC group received intravenous NAC (600 mg) before CECT imaging to prevent CIN. Both the NAC and control groups were treated using a standardized hydration strategy, where clinically feasible. Results The patients' mean age was 79.6±9.8 years. The prevalence of hypertension, diabetes, and chronic kidney disease (CKD) were 63.2%, 27.3%, and 21.5%, respectively. The baseline clinical characteristics were similar between the two groups except for their body weight (p=0.011), amount of contrast material adminis-tered (p=0.049) and prevalence of CKD (p=0.002). The incidence of CIN was 7.5% in the NAC group and 14.6% in the control group. The adjusted odds ratio was 0.305 (95% confidence interval: 0.097 to 0.960, p= 0.042). All-cause mortality was 7.5% in the NAC group and 12.6% in the control group, which was not sig-nificantly different. Temporary hemodialysis was required in 0% of subjects in the NAC group and 1.0% in the control group, which was not a statistically significant difference. Conclusion A single dose of NAC before CECT imaging can prevent CIN in an ED setting. However, it does not improve the mortality rate or the need for dialysis.

Original languageEnglish
Pages (from-to)2709-2714
Number of pages6
JournalInternal Medicine
Volume51
Issue number19
DOIs
Publication statusPublished - 2012
Externally publishedYes

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Keywords

  • Computed tomography
  • Contrast media
  • N-acetylcysteine
  • Nephropathy
  • Prevention

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Hsu, T. F., Huang, M. K., Yu, S. H., Yen, D. H. T., Kao, W. F., Chen, Y. C., & Huang, M. S. (2012). N-acetylcysteine for the prevention of contrast-induced nephropathy in the emergency department. Internal Medicine, 51(19), 2709-2714. https://doi.org/10.2169/internalmedicine.51.7894