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N-acetylcysteine for radiocontrast-induced nephropathy: Potential role in the emergency department?

Published online by Cambridge University Press:  21 May 2015

Elaine Chong  and
Peter J. Zed
Elaine Chong
Affiliation:
Clinical Services, Virtual Learning Inc., Toronto, Ont.
Peter J. Zed*
Affiliation:
CSU Pharmaceutical Sciences, Vancouver General Hospital, Faculty of Pharmaceutical Sciences & Associate Member, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC.
*
CSU Pharmaceutical Sciences, Vancouver General Hospital, 855 West 12th Ave., Vancouver BC V5Z 1M9; 604 875-4077, fax 604 875-5267, [email protected]

Abstract

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Objective:

To systematically review the efficacy and safety of N-acetylcysteine (NAC) for the prevention of radiocontrast-induced nephropathy (RIN), and to discuss its potential role in the emergency department.

Methodology:

We conducted a search of MEDLINE (from 1966 to December 2003), PubMed (1966 to December 2003) and EMBASE (1988 to December 2003) for English-language, prospective, randomized, controlled trials in humans using the search terms N-acetylcysteine, acetylcysteine, radiopharmaceuticals, contrast media, and kidney failure (acute).

Results:

Five trials support and 4 trials refute the hypothesis that NAC helps prevent RIN. In 7 of 9 trials, oral NAC was administered twice daily for 2 days, on the day before and on the day of the radiocontrast study — a regime not feasible for emergent situations. More recent trials suggest that adequate hydration and lower volumes of radiocontrast, rather than NAC, are more effective ways to prevent RIN.

Conclusion:

Although further study may be indicated, current evidence does not suggest that NAC has a role in the emergency prevention of RIN.

Keywords

N-acetylcysteineradiocontrastemergencyrenal failurenephropathy
Type
Pharmacotherapy • Pharmacothérapie
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 4 , July 2004 , pp. 253 - 258
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

References

1.Nissenson, AR.Acute renal failure: definition and pathogenesis. Kidney Int 1998;53:S7–10.Google Scholar
2.Pruchnicki, MC, Dasta, JF.Acute renal failure in hospitalized patients: Part I. Ann Pharmacother 2002;36:1261–7.CrossRefGoogle ScholarPubMed
3.Pruchnicki, MC, Dasta, JF.Acute renal failure in hospitalized patients: Part II. Ann Pharmacother 2002;36:1430–42.CrossRefGoogle ScholarPubMed
4.Asif, A, Preston, RA, Roth, D.Radiocontrast-induced nephropathy. Am J Ther 2003;10:137–47.Google Scholar
5.Gerlach, AT, Pickworth, KK.Contrast medium-induced nephrotoxicity: pathophysiology and prevention. Pharmacotherapy 2000;20:540–8.Google Scholar
6.McCullough, PA, Wolyn, R, Rocher, LL, Levin, RN, O’Neill, WW.Acute renal failure after coronary intervention: incidence, risk factors, and relationships to mortality. Am J Med 1997;103:368–75.Google Scholar
7.Waybill, MM, Waybill, PN.Contrast media-induced nephrotoxicity: identification of patients at risk and algorithms for prevention. J Vasc Interv Radiol 2001;12:3–9.CrossRefGoogle ScholarPubMed
8.Safirstein, R, Andrade, L, Vieira, JM.Acetylcysteine and nephro-toxic effects of radiographic contrast agents — a new use for an old drug. N Engl J Med 2000;343:210–2.Google Scholar
9.Tepel, M, van der, Giet M, Schwarzfeld, C, Laufer, U, Liermann, D, Zidek, W.Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 2000;343:180–4.CrossRefGoogle ScholarPubMed
10.Diaz-Sandoval, LJ, Kosowsky, BD, Losordo, DW.Acetylcysteine to prevent angiography-related renal tissue injury (the APART trial). Am J Cardiol 2002;89:356–8.CrossRefGoogle ScholarPubMed
11.Shyu, KG, Cheng, JJ, Kuan, P.Acetylcysteine protects against acute renal damage in patients with abnormal renal function undergoing a coronary procedure. J Am Coll Cardiol 2002;40: 1383–8.Google Scholar
12.Kay, J, Chow, WH, Chan, TM, Lo, SK, Kwok, ON, Yip, A, et al. Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and intervention: a randomized controlled trial. JAMA 2003;289:553–8.CrossRefGoogle ScholarPubMed
13.Baker, CSR, Wragg, A, Kumar, S, De Palma, R, Baker, LRI, Knight, CJ.A rapid protocol for the prevention of contrast-induced renal dysfunction: the RAPPID Study. J Am Coll Cardiol 2003;41:2114–8.Google Scholar
14.Briguori, C, Manganelli, F, Scarpato, P, Elia, PP, Golia, B, Riviezzo, G, et al. Acetylcysteine and contrast agent-associated nephrotoxicity. J Am Coll Cardiol 2002;40:298–303.Google Scholar
15.Allaqaband, S, Tumuluri, R, Malik, AM, Gupta, A, Volkert, P, Shalev, Y, et al. Prospective randomized study of N-acetylcysteine, fenoldopam, and saline for prevention of radiocontrast-induced nephropathy. Cathet Cardiovasc Intervent 2002;57:279–83.CrossRefGoogle ScholarPubMed
16.Durham, JD, Caputo, C, Dokko, J, Zaharakis, T, Pahlavan, M, Keltz, J, et al. A randomized controlled trial of N-acetylcysteine to prevent contrast nephropathy in cardiac angiography. Kidney Int 2002;62:2202–7.Google Scholar
17.Oldemeyer, JB, Biddle, WP, Wurdeman, RL, Mooss, AN, Cichowski, E, Hilleman, DE.Acetylcysteine in the prevention of contrast-induced nephropathy after coronary angiography. Am Heart J 2003;146:e23.Google Scholar
18.Holdiness, MR.Clinical pharmacokinetics of N-acetylcysteine. Clin Pharmacokinet 1991;20:123–34.Google Scholar
19.Birck, R, Krzossok, S, Markowetz, F, Schnulle, P, van der Woude, FJ, Braun, C.Acetylcysteine for prevention of contrast nephropathy: meta-analysis. Lancet 2003;362:598–603.Google Scholar
20.Borgstrom, L, Kagedal, B.Dose dependent pharmacokinetics of N-acetylcysteine after oral dosing to man. Biopharm Drug Dispos 1990;11:131–6.Google Scholar