Pharmacological Strategies to Prevent Contrast-Induced Acute Kidney Injury

Table 2

Prospective, randomized clinical trials comparing N-acetylcysteine with placebo for prophylaxis of contrast-induced AKI after angiography.

Authors	Year	Inclusion criteria	Type of procedure and contrast media	Number of patients; Intervention versus control	Study protocol		Intravascular volume expansion protocol	CI-AKI definition	Incidence of CI-AKI		RRT requirement; Intervention versus control (%)
					Intervention	Control			Intervention versus control (%)	𝑃 value
Tepel et al. [47]	2000	Cr >1.2 mg/dL or; GFR <50 mL/min/1.73 m^2	CECT; Iopromide	41 versus 42	NAC 600 mg po bid	None	N/2 1 mL/kg/h 12 hours before and after	↑Cr ≥25%/2 d or; ↑Cr ≥0.5/2 d	2 versus 21	0.01	0 versus 0
Shyu et al. [48]	2002	Cr 2–6 mg/dL or; GFR 8–40 mL/min/1.73 m^2	CAG; Iopamidol	60 versus 61	NAC 400 mg po bid	Placebo	0.45% NaCl 1 mL/kg/h 12 hours before and after	↑Cr ≥0.5/2 d	3.3 versus 24.6	<0.001	ND
Kay et al. [49]	2003	Cr >1.2 mg/dL or; GFR <60 mL/min/1.73 m^2	CAG; Iopamidol	102 versus 98	NAC 600 mg po bid	Placebo	NSS 1 mL/kg/h 12 hours before and 6 hours after with liberal oral fluid	↑Cr ≥25%/2 d	4 versus 12	0.03	ND
Baskurt et al. [110]	2009	GFR 30–60 mL/min/1.73 m^2	CAG; Ioversol	73 versus 72 versus 72	NAC 600 mg po bid	(1) None; (2) NAC 600 mg and theophylline 200 mg po bid	NSS 1 mL/kg/h 12 hours before and after	↑Cr ≥0.5/2 d	9.6 versus 6.9 versus 0	0.033	0 versus 0
Boccalandro et al. [133]	2003	Cr >1.2 mg/dL or; GFR <50 mL/min/1.73 m^2	CAG; Iodixanol	75 versus 106	NAC 600 mg po bid	None	0.45% NaCl; 75 mL/h 12 hours before and after	↑Cr ≥0.5/2 d	13 versus 12	0.842	ND
Webb et al. [50]	2004	GFR <50 mL/min/1.73 m^2	CAG; Ioversol	242 versus 245	Single dose of NAC 500 mg in D5W 50 mL IV 1 h before	D5W 50 mL	NSS 200 mL before and 1.5 mL/kg 6 hours after	↓GFR ≥5 mL/min/1.73 m^2	23.3 versus 20.7	0.51	20 versus 0
Gomes et al. [134]	2005	Cr >1.2 mg/dL	CAG; Ioxaglate	77 versus 79	NAC 600 mg po bid; 2 doses before and after	Placebo	NSS 1 mL/kg/h 12 hours before and after	↑Cr ≥0.5/2 d	10.4 versus 10.1	1.00	2.6 versus 0
Ozcan et al. [135]	2007	Cr 1.2–4 mg/dL	CAG; Ioxaglate	88 versus 88 versus 88	NAC 600 mg po bid with NSS 1 mL/kg/h 6 hours before and after	1 mL/kg/h for 6 hours before and after of; (1) Isotonic NaHCO3 IV; (2) NSS IV	—	↑Cr ≥25%/2 d or; ↑Cr ≥0.5/2 d	12.5 versus 4.5 versus 13.6	0.706; 0.081	0 versus 1.1 versus 1.1
ACT investigators [3]	2011	At least 1 risk factor for CI-AKI; (Age >70 years, Cr >1.5 mg/dL, DM, CHF, LVEF <0.45, hypotension)	CAG/PAG; ND	1,172 versus 1,136	NAC 600 mg po bid	Placebo	NSS 1 mL/kg/h × 6–12 hours before and after	↑Cr 25%/2–4 d	12.7 versus 12.7	0.97	2.2 versus 2.3

bid: twice daily; CAG: coronary angiography; CECT: contrast enhanced computed tomography; CI-AKI: contrast-induced acute kidney injury; CHF: congestive heart failure; Cr: creatinine; d: day; DM: diabetes mellitus; D5W: 5% dextrose solution; GFR: glomerular filtration rate; h: hour; IV: intravenous; kg: kilogram body weight; LVEF: left ventricular ejection fraction; mg: milligram; mL: milliliter; NAC: N-acetylcysteine; ND: no data; NSS: normal saline solution; N/2: 0.45% NaCl; PAG: peripheral angiography; po: per oral route; RRT: renal replacement therapy.