Intravascular radiocontrast use can...

Intravascular radiocontrast use can arise in contrast nephropathy, which present itselfs more commonly in patients with diabetes and renal insufficiency. This adverse result rarely results in a ne for dialysis further can increase morbidity and mortality and defer hospital stays. Saline hydration and low-osmolar contrast agents have been shown to cut down the incidence of nephropathy. acetylcysteine (NAC) administration has been associated with decreased adverse circumstances but the magnitude of the benefit has not been clearly quantitated. Isenbarger and associates reviewed randomized clinical trials of NAC for prevention of contrast nephropathy to assess the grade of benefit.

The contemplation included prospective trials that compared NAC plus saline hydration with saline hydration alone, with and without placebo superintendences in patients prepared for angiography or comput tomography. Seven studies were included in the analysis. Non-ionic, low-osmolar contrast material was used in all studies, and the serum creatinine flush was measured 48 hours after administration. Contrast nephropathy was defined as an increase in the serum creatinine flat of greater than 0.5 mg through dL (44 mmol per L) or greater than 25 percent from baseline.

The supernumerarys of developing contrast nephropathy were significantly lower in patients using NAC before contrast administration. Nine patients would have to be treated with NAC to stop one episode of nephropathy. This tenor was not related to the baseline creatinine of the same height the contrast volume, or the percentage of patients with diabetes.

The authors deduce that, although the clinical significance of contrast nephropathy is debatable because its impact onward mortality is uncertain, administering NAC before contrast material in susceptible patients could decrease the long duration of hospital stay and obstruct chronic worsening of renal function. The use of saline hydration attenuates the perceived benefit of NAC. Because benefits have been observ and NAC is gentle in cost and easy to administer, routine prophylactic use of NAC is commended in patients with stable chronic renal insufficiency or diabetes who are undergoing elective angiography.

RICHARD SADOVSKY, MD Isenbarger DW et al. Meta-analysis of randomized clinical trials forward the usefulness of acetylcysteine for prevention of contrast nephropathy. Am J Cardiol December 15 2003;92:1454-8

EDITOR'S NOTE: Prevention of contrast nephropathy is a high priority because of the risk of permanently worsened renal function and longer hospital stays. the pair acetylcysteine (NAC) and intravenous hydration have proven useful in this setting. Isotonic hydration started before elective or difficulty coronary angiography and continued until the nearest morning reduces the rate of contrast nephropathy. (1) A protocol for intra-venous administration of NAC in patients with chronic stable renal insufficiency who are having coronary intervention with contrast medium demonstrates that 150 mg through kg in 500 mL of normal saline administered throughout 30 minutes immediately before contrast prospect and 50 mg per kg in 500 mL of saline from one side of to the other the subsequent four hours favorably reduces contrast nephropathy compared with intravenous saline hydration alone. (2) --RS

References

(1) Mueller C Buerkle G Buettner HJ Petersen J Perruchoud AP, Eriksson U et al. Prevention of contrast media-associated nephropathy. Randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern M 2002;162:329-36

(2) Baker C Wragg A, Kumar s De Palma R, Baker LR Knight CJ A rapid protocol for the prevention of contrast-induced renal dysfunction: the RAPPID research J Am Coll Cardiol 2003;41:2114-8

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