Can N-Acetylcysteine Prevent Acute Renal Failure in Chronic Liver Disease Patients Undergoing Triple Phase CT Scan?

Abstract

Purpose: 1)To determine if beneficial effects of N-Acetylcysteine in cardiac catheterization patients could be seen in patients with chronic liver disease 2)To determine if N-Acetylcysteine may lower the incidence of acute renal failure in patients with chronic liver disease. Methods: 400 patients with chronic liver disease were evaluated based on renal function before and after Triple Phase Abdominal CT Scan by a practicing hepatologist at Loyola. N-Acetylcysteine (NAC) was administered at a dose of 140 mg/kg, 4 hours before and 2 and 4 hours after the procedure. Renal function was assessed at baseline, 24, and 48 hours after completion of CT scan. The data were used to devise a retrospective study approved by the IRB to compare those who received NAC before and after administration of contrast material. Patients were categorized based on baseline renal function. Indications for CT Scan included those patients with chronic liver disease. Control patients received no NAC prior to or after CT scan. We accepted an increase in creatinine of .3 mg/dl as our definition of renal failure. Results: Patients with baseline renal insufficiency reponded much more favorably to administation of NAC than patients with normal renal function. Those with a baseline creatinine greater than 1.3 mg/dl demonstrated 10% fewer cases of acute renal failure when receiving NAC. Results clearly show a statistical trend toward protective effect on kidney in patients with renal insufficiency at baseline (p=.0009). Conclusions: Radiocontrast-Induced Nephropathy is a significant cause of acute renal failure in hospitalized patients. In cases of oxidative stress like that of acetaminophen toxicity, patients respond well to higher doses of NAC. Currently, there are no studies that document the effects of high dose NAC on renal function in chronic liver disease patients. This study demonstrates the beneficial effect of NAC on renal function in patients with chronic liver disease. A larger study will be necessary to elucidate a stronger association between NAC and its protective effect on renal function in liver disease patients. [figure 1]Figure 1