Abstract
Background: Contrast-induced acute kidney injury (CI-AKI) is one of the possible complications in angiography, which its prevention is important. N-acetylcysteine is one of the compounds that has recently been more investigated regarding its effect on CI-AKI. Objectives: The aim of this study was to investigate the effect of standard dose and twice-thestandard of N-acetyl cysteine on prevention of contrast-induced nephropathy. Patients and Methods: In a clinical trial, 154 individuals who were referred for angiography and had glomerular filtration rate (GFR) ≤60 mL/min, enrolled in and randomly divided into two groups. Group A received the usual dose of N-acetyl cysteine and group B received twice the standard. Blood urea nitrogen (BUN), creatinine, and GFR values were measured and recorded at intervals before, 24, 48 and 72 hours after angiography. Other required laboratory parameters were also measured and recorded. Results: The results of this study indicated that the effect of double dose in males and females is not different. It also has a reverse effect on renal function in older patients. Its effect did not differ in diabetic patients compared to non-diabetic patients. N-acetyl cysteine in dose of twice the standard has not any effect on renal function in patients with hyperlipidemia, hypertension, myocardial infarction, pulmonary edema as well as smoker patients. In patients with congestive heart failure (CHF), N-acetyl cysteine in dose of twice the standard had a positive effect on renal function compared with those who did not have CHF. An interesting point in our study was the negative effect of N-acetyl cysteine in dose of twice-the-standard on renal function in patients with lower hemoglobin and hematocrit levels. Conclusions: Our study showed that an increase in the dose of N-acetyl cysteine is not effective in preventing contrast-induced nephropathy and improving renal function. Of course, in some groups, such as those with CHF, a positive effect was detected. Additionally, in some groups including patients with lower hematocrit and hemoglobin, an increase in dose is associated with a negative effect on renal function.
Highlights
Contrast-induced acute kidney injury (CI-AKI) is one of the possible complications in angiography, which its prevention is important
Analytical results The analytical results showed no significant differences between the two groups in terms of Blood urea nitrogen (BUN), creatinine and glomerular filtration rate (GFR) 24, 48 and 72 hours after the angiography or angioplasty (Mann-Whitney U test)
Significant differences in mean BUN, creatinine and GFR before and 24, 48 and 72 hours after angiography in the patients with a hematocrite less than and more than 36 were observed
Summary
Contrast-induced acute kidney injury (CI-AKI) is one of the possible complications in angiography, which its prevention is important. In addition to inhibiting oxygen free radicals, N-acetylcysteine can establish normal renal hemodynamics through the effects of vasodilation, and by controlling all the above three mechanisms for the development and progression of CI-AKI, N-acetylcysteine is predicted to be a good medication for the prevention and treatment of CI-AKI [1,2,5] This subject was first studied in 2000, and the results obtained were satisfactory, such that N-acetylcysteine was able to reduce the prevalence of CI-AKI significantly, from 21% to 2% in the group receiving this medication compared to the group that received hydration treatment [6]. The results of an extensive retrospective study conducted on 2308 patients receiving contrast agents showed that the prevalence of CI-AKI was 12.7% in both the N-acetylcysteine and control groups, and the two groups were not significantly different regarding serum creatinine, and this finding contradicts the results of other studies [4]. The American Heart Association and the American College of Cardiology have not recommended this medication and considered proper hydration sufficient for the patients [10]
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