N-acetylcysteine does not prevent contrast nephropathy in patients with renal impairment undergoing emergency CT: a randomized study

Poletti, Pierre-Alexandre Alois; Platon, Alexandra; De Seigneux Matthey, Sophie; Dupuis Lozeron, Elise; Sarasin, François; Becker, Christoph; Perneger, Thomas; Saudan, Patrick; Martin, Pierre-Yves

doi:10.1186/1471-2369-14-119

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Title		N-acetylcysteine does not prevent contrast nephropathy in patients with renal impairment undergoing emergency CT: a randomized study
Authors		Poletti, Pierre-Alexandre Alois Platon, Alexandra De Seigneux Matthey, Sophie Dupuis Lozeron, Elise Sarasin, François Becker, Christoph Perneger, Thomas Saudan, Patrick Martin, Pierre-Yves show all authors [1 - 9]
Published in		BMC Nephrology. 2013, vol. 14, no. 1, p. 119
Abstract		BACKGROUND: Patients admitted to the emergency room with renal impairment and undergoing a contrast computed tomography (CT) are at high risk of developing contrast nephropathy as emergency precludes sufficient hydration prior to contrast use. The value of an ultra-high dose of intravenous N-acetylcysteine in this setting is unknown. METHODS: From 2008 to 2010, we randomized 120 consecutive patients admitted to the emergency room with an estimated clearance lower than 60 ml/min/1.73 m2 by MDRD (mean GFR 42 ml/min/1.73 m2) to either placebo or 6000 mg N-acetylcysteine iv one hour before contrast CT in addition to iv saline. Serum cystatin C and creatinine were measured one hour prior to and at day 2, 4 and 10 after contrast injection. Nephrotoxicity was defined either as 25% or 44 mumol/l increase in serum creatinine or cystatin C levels compared to baseline values. RESULTS: Contrast nephrotoxicity occurred in 22% of patients who received placebo (13/58) and 27% of patients who received N-acetylcysteine (14/52, p = 0.66). Ultra-high dose intravenous N-acetylcysteine did not alter creatinine or cystatin C levels. No secondary effects were noted within the 2 groups during follow-up. CONCLUSIONS: An ultra-high dose of intravenous N-acetylcysteine is ineffective at preventing nephrotoxicity in patients with renal impairment undergoing emergency contrast CT.Trial registration: The study was registered as Clinical trial (NCT01467154).
Identifiers		DOI: 10.1186/1471-2369-14-119 PMID: 23731573
Full text		Article (Published version) (534 Kb) - Free access
Structures		Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de radiologie et informatique médicale Faculté d'économie et de management / Research Center for Statistics
Research groups		Epidémiologie clinique (115) Groupe Pierre-Yves Martin (néphrologie) (30) Imagerie et radiologie interventionnelle du foie, des voies biliaires et du pancréas (316) Insuffisance rénale chronique (941) Radiologie des urgences (800)
Citation (ISO format)		POLETTI, Pierre-Alexandre Alois et al. N-acetylcysteine does not prevent contrast nephropathy in patients with renal impairment undergoing emergency CT: a randomized study. In: BMC Nephrology, 2013, vol. 14, n° 1, p. 119. https://archive-ouverte.unige.ch/unige:29959