Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and intervention: A randomized controlled trial

Jay KAY, Wing Hing CHOW, Tak Mao CHAN, Sing Kai LO, On Hing KWOK, Alex YIP, Katherine FAN, Chi Hang LEE, Wai Fai LAM

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Abstract

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. Copyright © 2003 American Medical Association.
Original languageEnglish
Pages (from-to)553-558
JournalJournal of the American Medical Association
Volume289
Issue number5
DOIs
Publication statusPublished - 2003

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Acetylcysteine
Coronary Angiography
Randomized Controlled Trials
Creatinine
Kidney
Confidence Intervals
Serum
Renal Insufficiency
Angiography
Placebos
Hong Kong
Chronic Renal Insufficiency
Osmolar Concentration
Contrast Media
Tablets
Antioxidants
Tomography
Outcome Assessment (Health Care)
Costs and Cost Analysis
Control Groups

Citation

Kay, J., Chow, W. H., Chan, T. M., Lo, S. K., Kwok, O. H., Yip, A., . . . Lam, W. F. (2003). Acetylcysteine for prevention of acute deterioration of renal function following elective coronary angiography and intervention: A randomized controlled trial. Journal of the American Medical Association, 289(5), 553-558. doi: 10.1001/jama.289.5.553