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Document Details :

Title: Acetylcysteine, coronary procedure and prevention of contrast-induced worsening of renal function
Subtitle: Which benefit for which patient?
Author(s): KEFER, Joëlle M. , HANET, Claude E. , BOITTE, Sabine , WILMOTTE, Léon , DE KOCK, Martine
Journal: Acta Cardiologica
Volume: 58    Issue: 6   Date: December 2003   
Pages: 555-560
DOI: 10.2143/AC.58.6.2005321

Abstract :
Objectives — This study was designed to determine whether acetylcysteine could provide a protective effect on renal function in a population of patients with normal renal function or mild to moderate chronic renal failure, usually referred for a coronary procedure.

Background— Contrast-induced nephropathy is a well-recognized complication of coronary angiography. Recent studies suggest that saline hydration and acetylcysteine reduce the incidence of contrast-induced worsening of renal function in patients with pre-existing chronic renal failure who are undergoing computed tomography examinations.

Methods — One hundred eight patients were blindly and randomly assigned to receive either acetylcysteine or placebo before and after administration of contrast agent in association with a moderate hydration protocol. Serum creatinine and urea nitrogen were measured before and 24 hours after coronary procedure.

Results — The mean serum creatinine concentration remained unchanged 24 hours after contrast agent administration in both groups:from 1.04??±??0.26 to 1.03??±??0.29 mg/dl in the acetylcysteine group
and from 1.16±1.1 to 1.06±0.41 mg/dl in the control group (p=0.29,for the comparison between two groups, NS).
We divided the population into 3 subgroups according to their creatinine clearance: no significant change of serum creatinine concentration was observed in patients with normal renal function nor in patients with pre-existing mild to moderate chronic renal failure in both groups.
There was no significant difference for the incidence of contrast-induced nephropathy between both groups (2 of the 53 patients in the acetylcysteine group and 3 of the 51 patients in the placebo group, p=0.98, NS).

Conclusions — Our data do not support the systematic use of acetylcysteine before a coronary procedure in patients with normal renal function or mild to moderate chronic renal failure,to prevent contrast-induced nephropathy.