Comparison of oral N-acetylcysteine(NAC) and prehydration for preventing contrast-induced nephropathy in patients with renal dysfunction / 대한내과학회지

ABSTRACT

BACKGROUND: Contrast induced nephropathy (CIN) is an important cause of acute renal failure in patients with renal dysfunction. We investigated whether oral NAC alone was sufficient to prevent CIN to the same extent as hydration in patients with renal dysfunction, and whether these treatments resulted in diffierences in the urinary excretion of nitric oxide, a vasodilator. METHODS: A total of 27 patients with renal dysfunction, who underwent radiographic examination with nonionic and low osmolar contrast, were randomly assigned to receive either NAC (600 mg orally twice daily; N=11) or 0.45% saline hydration (1 mL/kg/Hr; N=16) 12 hours prior to and 12 hours after the contrast procedure. We measured serum creatinine (sCr), fractional excretion of sodium (FENa), creatinine clearance (CCr), and urinary nitrite before and after contrast administration. RESULTS: The mean volume of contrast used was similar in the two groups (100.9+/-54.8 mL vs 114.7+/-38 mL; p=0.43), as was baseline sCr in the two groups (2.31+/-1.59 mg/dL vs 2.18+/-1.41 mg/dL; p=0.98). Treatment did not significantly affect the incidence of CIN, with 18.2% and 12.5% in the NAC group and hydration group, respectively (p=1.0). The urinary nitrite/creatinine ratio (micro mol/mg) was 1.26+/-0.57 and 1.43+/-0.64 at baseline and 48 hours after contrast exposure in the NAC group, respectively, and 0.80+/-0.40 and 1.18+/-0.60 in the hydration group, respectively, which were not significantly different. FENa increased significantly after contrast exposure in the NAC group compared with hydration group (p=0.04) CONCLUSIONS: NAC alone may prevent CIN. When bolus hydration is contraindicated in patients with renal dysfunction, administration of NAC alone may be sufficient.