Comparison of the effects of nebivolol and N-acetylcysteine which are added to hydration theraphy in the prevention of contrast induced nephropathy

Abstract

Aim: Contrast-induced nephropathy (CIN) is a serious complication occurring after the administration of contrast materials to patients at risk of acute renal injury. Nebivolol is a third generation beta blocker which has anti-apoptotic and anti-oxidant properties. In addition, it has vasodilatator effect via increasing nitric oxide level. So, the aim of the study was to compare the effectiveness of prophylactic nebivolol use versus pretreatment with N-Acetylcysteine (NAC) for prevention of CIN after coronary angiography. Patients and methods: We prospectively enrolled 99 patients who were scheduled for elective coronary angiography procedure and whose baseline creatinin levels between 1.2 and 1.7 mg/dl. Patients were divided into three groups. Group I (NAC group) consisted of the patients received NAC plus hydration, group II (nebivolol group) nebivolol plus hydration and, group III (hydration group) only hydration. In group II, patients received oral nebivolol (5 mg/dose, n = 33) once a day for total 3 doses before coronary angiography, starting two days before angiography and continuing at the morning of angiography day. CIN was defined as an increase of ≥0.5 mg/dl or an increase of >25% in serum creatinine over baseline at 2-day or 5-day after coronary angiography in the first definition. Results: Treatment groups were similar with respect to baseline clinical characteristics. Serum creatinine levels at 2-day and 5-day were not significantly different in the three groups (p=0.96 and p=0.79, respectively). CIN occurred in 18.2% (6/33) of patients in group I, 24.2% (8/33) in group II, and 24.2% (8/33) in group III (p=0.79). Also, the incidence of CIN in diabetic patients was not different in the three treatment groups (p=0.16). Although the incidence of CIN was not different in the three groups (p=0.30), in the diabetic subgroup, CIN occurred in 20% (2/10) of patients taking nebivolol, none of patients taking NAC and 55.6% (5/9) of patients administered only hydration (p=0.01). Conclusion: Both nebivolol and NAC which was added to hydration theraphy didn't reduced the risk of CIN in patients with reduced renal function undergoing elective coronary angiography. This study demonstrated the protective effect of NAC on CIN in only diabetic patients.