Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and intervention

Kay, Jay, Chow, Wing Hing, Chan, Tak Mao, Lo, Sing Kai, Kwok, On Hing, Yip, Alex, Fan, Katherine, Lee, Chi Hang and Lam, Wai Fai 2003, Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and intervention, JAMA : the journal of the American Medical Association, vol. 289, no. 5, pp. 553-558.

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Title Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and intervention
Author(s) Kay, Jay
Chow, Wing Hing
Chan, Tak Mao
Lo, Sing Kai
Kwok, On Hing
Yip, Alex
Fan, Katherine
Lee, Chi Hang
Lam, Wai Fai
Journal name JAMA : the journal of the American Medical Association
Volume number 289
Issue number 5
Start page 553
End page 558
Publisher American Medical Association
Place of publication Chicago, Ill.
Publication date 2003-02-05
ISSN 0098-7484
Keyword(s) randomized controlled trial
Summary Context The antioxidant acetylcysteine prevents acute contrast nephrotoxicity in patients with impaired renal function who undergo computed tomography scanning. However, its role in coronary angiography is unclear.

Objective To determine whether oral acetylcysteine prevents acute deterioration in renal function in patients with moderate renal insufficiency who undergo elective coronary angiography.

Design and Setting Prospective, randomized, double-blind, placebo-controlled trial conducted from May 2000 to December 2001 at the Grantham Hospital at the University of Hong Kong.

Participants Two hundred Chinese patients aged mean (SD) 68 (6.5) years with stable moderate renal insufficiency (creatinine clearance <60 mL/min [1.00 mL/s]) who were undergoing elective coronary angiography with or without intervention.

Intervention Participants were randomly assigned to receive oral acetylcysteine(600 mg twice per day; n = 102) or matching placebo tablets (n = 98) on the day before and the day of angiography. All patients received low-osmolality contrast agent.

Main Outcome Measures Occurrence of more than a 25% increase in serum creatinine level within 48 hours after contrast administration; change in creatinine clearance and serum creatinine level.

Results Twelve control patients (12%) and 4 acetylcysteine patients (4%) developed a more than 25% increase in serum creatinine level within 48 hours after contrast administration (relative risk, 0.32; 95% confidence interval [CI], 0.10-0.96; P = .03). Serum creatinine was lower in the acetylcysteine group (1.22 mg/dL [107.8 µmol/L]; 95% CI, 1.11-1.33 mg/dL vs 1.38 mg/dL [122.9 µmol/L]; 95% CI, 1.27-1.49 mg/dL; P = .006) during the first 48 hours after angiography. Acetylcysteine treatment significantly increased creatinine clearance from 44.8 mL/min (0.75 mL/s) (95% CI, 42.7-47.6 mL/min) to 58.9 mL/min (0.98 mL/s) (95% CI, 55.6-62.3 mL/min) 2 days after the contrast administration (P<.001).The increase was not significant in the control group (from 42.1 to 44.1 mL/min [0.70 to 0.74 mL/s]; P = .15). The benefit of acetylcysteine was consistent among various patient subgroups and persistent for at least 7 days. There were no major treatment-related adverse events.

Conclusion Acetylcysteine protects patients with moderate chronic renal insufficiency from contrast-induced deterioration in renal function after coronary angiographic procedures, with minimal adverse effects and at a low cost.
Language eng
Field of Research 119999 Medical and Health Sciences not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2003, American Medical Association
Persistent URL http://hdl.handle.net/10536/DRO/DU:30009354

Document type: Journal Article
Collection: School of Health and Social Development
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