Abstract
BackgroundPatients with diabetes mellitus (DM) and chronic kidney disease (CKD) constitute to be a high-risk population for the development of contrast-induced nephropathy (CIN), in which the incidence of CIN is estimated to be as high as 50%. We performed this trial to assess the efficacy of N-acetylcysteine (NAC) in the prevention of this complication.MethodsIn a prospective, double-blind, placebo controlled, randomized clinical trial, we studied 90 patients undergoing elective diagnostic coronary angiography with DM and CKD (serum creatinine ≥ 1.5 mg/dL for men and ≥ 1.4 mg/dL for women). The patients were randomly assigned to receive either oral NAC (600 mg BID, starting 24 h before the procedure) or placebo, in adjunct to hydration. Serum creatinine was measured prior to and 48 h after coronary angiography. The primary end-point was the occurrence of CIN, defined as an increase in serum creatinine ≥ 0.5 mg/dL (44.2 μmol/L) or ≥ 25% above baseline at 48 h after exposure to contrast medium.ResultsComplete data on the outcomes were available on 87 patients, 45 of whom had received NAC. There were no significant differences between the NAC and placebo groups in baseline characteristics, amount of hydration, or type and volume of contrast used, except in gender (male/female, 20/25 and 34/11, respectively; P = 0.005) and the use of statins (62.2% and 37.8%, respectively; P = 0.034). CIN occurred in 5 out of 45 (11.1%) patients in the NAC group and 6 out of 42 (14.3%) patients in the placebo group (P = 0.656).ConclusionThere was no detectable benefit for the prophylactic administration of oral NAC over an aggressive hydration protocol in patients with DM and CKD.Trial registrationNCT00808795
Highlights
Patients with diabetes mellitus (DM) and chronic kidney disease (CKD) constitute to be a high-risk population for the development of contrast-induced nephropathy (CIN), in which the incidence of CIN is estimated to be as high as 50%
Patients Of the 90 patients enrolled in the study, 3 patients in placebo group were lost to follow-up because of immediate hospital discharge after coronary angiography and failure to have subsequent blood sampling performed
There were no significant differences between the treatment groups with regard to CHD risk factors, baseline serum creatinine, and urea nitrogen concentration or Creatinine clearance (CrCl) except for the gender, which was significantly different between the two groups of patients (P = 0.005)
Summary
Patients with diabetes mellitus (DM) and chronic kidney disease (CKD) constitute to be a high-risk population for the development of contrast-induced nephropathy (CIN), in which the incidence of CIN is estimated to be as high as 50%. We performed this trial to assess the efficacy of N-acetylcysteine (NAC) in the prevention of this complication. Patients at the greatest risk for CIN can be defined as those that have preexisting impaired renal function and diabetes mellitus with the incidence estimated to be as high as 50% [9] These patients constitute to be an appropriate target population for efforts at prevention of this important complication. Seems that we need more evidence about the efficacy and cost-effectiveness of NAC in patients at high risk for the development of CIN to make rational clinical decisions for individual patients as well as policy decisions for the health of the general public
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