Preventing side effects of radiographic contrast agents with N-acetylcysteine

Townsend Letter for Doctors and Patients,  Feb, 2001  by Alan R. Gaby

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Eighty-three patients with chronic renal insufficiency (mean serum creatinine, 2.4 mg/dl) who were undergoing computed tomography with a contrast agent were randomly assigned to receive N-acetylcysteine (NAC) or placebo (blinding not specified). The dosage of NAC was 600 mg orally twice daily, on the day before and the day of administration of the contrast agent. Both groups received intravenous hydration with 0.45% saline. An increase of at least 0.5 mg/dl in the serum creatinine concentration 48 hours after administration of the contrast agent was seen in 2.4% of the patients in the NAC group, compared with 21% of those in control group (risk reduction = 89%; p = 0.01). In the NAC group, the mean serum creatinine concentration decreased significantly (p [less than]0.001) from 2.5 to 2.1 mg/dl 48 hours after administration of the contrast agent, compared with a nonsignificant increase in the control group from 2.4 to 2.6 mg/dl (p [less than] 0.001 for the difference between groups).

Comment: Administration of radiographic contrast agents often causes an acute reduction in renal function that can result in significant morbidity and mortality and can lead to chronic renal failure. There is evidence that contrast agent induced renal damage is due to oxygen-derived free radicals. The present study demonstrated that the antioxidant NAC, when administered along with hydration, prevented the reduction in renal function induced by contrast agents in patients with chronic renal insufficiency. This simple and inexpensive intervention could greatly reduce the adverse effects that result from this common diagnostic procedure.

Tepel M, et al. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 2000;343:180-184.

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