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document
Prehydration alone is sufficient to prevent contrast-induced nephropathy after day-only angiography procedures -- a randomised controlled trial . BACKGROUND Contrast agents used in angiography procedures for patients with cardiovascular disease are known to cause contrast-induced nephropathy ( CIN ) , which may be partially due to the production of nephrotoxic oxygen-free radicals . It is uncertain whether administration of intravenous ( IV ) anti-oxidant , N-acetylcysteine ( NAC ) , can prevent reduction in renal function and whether this is a cost-effective approach . METHODS Sixty-five day-only patients with renal impairment ( mean serum creatinine concentration 0.16+/-0.03 mmol/l ) due to undergo coronary or peripheral angiography and/or stenting were randomly assigned to IV NAC 300 or 600 mg immediately before and after the procedure or IV fluid alone . RESULTS Of the 60 patients with complete data , none had acute CIN ( increase in serum creatinine concentration > or = 0.044 mmol/l , 48 h after administration of contrast agent ) . Eight patients ( 13 % ) have demonstrated an increase in their serum creatinine concentration > or = 0.044 mmol/l 30 days after administration of contrast agent : 2/19 ( 11 % ) in the control group , 2/21 ( 10 % ) in the 600 mg NAC group and 4/20 ( 20 % ) the 300 mg NAC group ( p = 0.66 ) . The mean volumes of contrast agent used and prehydration given for each of the three groups did not differ significantly ( p > 0.83 ) . There was significant improvement in creatinine clearance within each group from baseline to 30 days ( p < or = 0.03 ) , but no significant difference between the groups at 48 h and 30 days ( p > or = 0.43 ) . Considering the cost of NAC and its administration , we estimate that this would translate to a saving of dollar 26,637 per annum . CONCLUSION For day-stay patients with mild-to-moderate chronic renal impairment undergoing angiography and/or intervention , prehydration alone is less complicated and more cost-effective than a combination of IV NAC ( at doses used ) and hydration .
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Intervention_Pharmacological
intravenous ( IV ) anti-oxidant
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Intervention_Pharmacological
N-acetylcysteine ( NAC )
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Intervention_Pharmacological
IV NAC 300 or 600
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Intervention_Pharmacological
NAC
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Outcome_Physical
serum creatinine concentration
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Outcome_Other
mean volumes of contrast agent
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Outcome_Physical
creatinine clearance
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Outcome_Other
saving
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Participant_Condition
angiography procedures
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Participant_Condition
cardiovascular disease
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Participant_Sample-size
Sixty-five
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Participant_Condition
renal impairment ( mean serum creatinine concentration 0.16+/-0.03 mmol/l )
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Participant_Condition
undergo coronary or peripheral angiography and/or stenting
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Participant_Sample-size
60
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Participant_Condition
mild-to-moderate chronic renal impairment undergoing angiography and/or intervention