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Open Access Highly Accessed Research article

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

Pierre-Alexandre Poletti1*, Alexandra Platon1, Sophie De Seigneux2, Elise Dupuis-Lozeron3, François Sarasin4, Christoph D Becker1, Thomas Perneger3, Patrick Saudan2 and Pierre-Yves Martin2

Author affiliations

1 Department of Radiology, University Hospital of Geneva, Geneva, Switzerland

2 Service of Nephrology, Department of Internal Medicine specialties, University Hospital of Geneva, Geneva, Switzerland

3 Division of Clinical Epidemiology, University Hospital of Geneva, Geneva, Switzerland

4 Service of Emergency Medicine, University Hospital of Geneva, Geneva, Switzerland

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Citation and License

BMC Nephrology 2013, 14:119  doi:10.1186/1471-2369-14-119

Published: 3 June 2013

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 μmol/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).

Keywords:
Computerized Tomography; Contrast media; Emergency medicine; N-acetylcysteine; Nephrotoxicity