Acetylcysteine for Prevention of Contrast-Induced Nephropathy

Daniel J. Pallin, MD, MPH

Hydration with normal saline alone may be the best approach for most patients.

Many studies have evaluated approaches to prevention of contrast-induced nephropathy (CIN), including oral or intravenous hydration, bicarbonate infusion, and administration of acetylcysteine, an antioxidant and glutathione substitute. These investigators compared IV acetylcysteine plus normal saline to normal saline alone in a randomized trial of emergency department patients undergoing chest or abdominal computed tomography with IV contrast who had at least one risk factor for CIN.

CIN was defined as an increase in creatinine of 25% or 0.5 mg/dL within 48 to 72 hours after contrast administration. The study was stopped early for futility because the incidence of CIN did not differ between groups and the safety monitoring board did not think enrolling more patients would change this observation. Interestingly, patients with a baseline creatinine >1.2 mg/dL benefitted from acetylcysteine, but the study was not designed to be discriminatory in this subgroup and the results were not statistically significant. Aside from acetylcysteine, larger volumes of fluid were protective: The odds for CIN were 0.41 for each liter given.

Citation(s):

Traub SJ et al. N-acetylcysteine plus intravenous fluids versus intravenous fluids alone to prevent contrast-induced nephropathy in emergency computed tomography. Ann Emerg Med 2013 Nov; 62:511.