Issues in cardiovascular nursingEfficacy of N-acetylcysteine and hydration versus placebo and hydration in decreasing contrast-induced renal dysfunction in patients undergoing coronary angiography with or without concomitant percutaneous coronary intervention
Section snippets
Background
The toxic effects of contrast media have been known for more than half a century. Many studies have looked at the use of different treatment modalities to reduce the incidence or degree of renal impairment incurred with the use of contrast media in coronary angiography, including hydration, furosemide, dopamine, mannitol, calcium channel blockers, and atrial natriuretic peptide, as well as low and high osmolar contrast agents.8, 10, 11, 12, 13, 14, 15, 16, 17, 18 To date, no treatment modality
Purpose
The purpose of this study was to examine the efficacy of N-acetylcysteine and hydration in decreasing the incidence of CIRD in patients who present with an ACS. The hypotheses were that N-acetylcysteine and intravenous hydration would decrease the incidence of CIRD, attenuate the change in serum creatinine, and maintain or improve the level of creatinine clearance after contrast media exposure.
Design
A prospective, double-blind, randomized, placebo, controlled trial was used to assess the efficacy of oral N-acetylcysteine and intravenous hydration in decreasing the incidence of CIRD in patients admitted with an ACS and renal dysfunction who underwent risk stratification with coronary angiography with or without concomitant percutaneous coronary intervention (PCI). Patients received similar intravenous hydration of .45% normal saline at 1 mL/kg/h 4 to 6 hours before and 12 hours after
Screening and final study cohort
There were 132 patients screened for possible enrollment into the study. Of the patients screened, 19 were excluded on the basis of heart failure, 19 were risk stratified using methods other than coronary angiography, 18 declined participation, 17 underwent primary angiography, 5 were enrolled in another investigation at the time of screening, and 5 had a diagnosis of either dementia, inebriation, or encephalopathy, and were unable to give informed consent, 4 were unable to read or write
Discussion
The incidence of CIRD is typically 10% to 40% in patients who undergo coronary angiography with evidence of renal dysfunction.2, 3 On the basis of two definitions of CIRD, the incidence observed was 7.5% in this study cohort. The lower incidence of CIRD found at this institution can be attributed to the practices currently implemented for identified patients with renal dysfunction (alternative imaging techniques, use of third-generation contrast agents, and minimizing contrast volume during
Conclusion
The use of N-acetylcysteine in ACS was conducted over a 10-month period in patients with biochemical evidence of renal dysfunction undergoing coronary angiography with or without concomitant PCI. The use of N-acetylcysteine and intravenous hydration with .45% normal saline showed a trend toward decreasing the incidence of CIRD in this patient cohort. From the results of this study and a review of the current literature, several cohorts have been identified who require further investigations
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The effect of N-acetylcysteine on the incidence of contrast-induced kidney injury: A systematic review and trial sequential analysis
2016, International Journal of CardiologyCitation Excerpt :Subgroup analysis was conducted to determine whether any factors were particularly associated with lower AKI rates with NAC use. In the eight studies [21,28,36,43,50,52–54] that included only ACS patients, there was a trend towards lower AKI rates in the NAC group which did not reach significance (OR 0.758; 95% CI, 0.538–1.066; I2 = 38.56%; p = 0.111). In the no-ACS subgroup, there was a significantly lower AKI rate in the groups taking NAC compared to controls (OR, 0.642; 95% CI, 0.492–0.838; I2 = 33.73%; p = 0.001).
Contrast induced nephropathy in vascular surgery
2016, British Journal of AnaesthesiaCitation Excerpt :NAC is inexpensive, easy to administer and has a favourable safety profile (although not totally harmless, as anaphylactoid reactions have been reported when used via the i.v. route in other clinical contexts45); it also may have free radical scavenging and organ protective effects.46 However the results regarding its efficacy are equivocal and to date no firm recommendations can be given for its routine use, especially in light of the ACT trial (see Table 2).13 14 47–69 This is probably attributable to heterogeneity in the design of the studies, ranging from definition of CIN, types of CM used, co-morbidities of patients, dose of NAC, routes of administration and of the co-interventions used, most notably that of hydration protocols.
Novel approach for the prevention of contrast nephropathy
2010, Experimental and Toxicologic PathologyN-acetylcysteine: Multiple clinical applications
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