Abstract 3066: Comparison of Two Antioxidants, N-Acetylcysteine and Ascorbic Acid for Prevention of Contrast Induced Nephropathy in Renal Insufficiency Undergoing Coronary Catheterization: A Prospective Randomized Controlled Trial
Background: Contrast induced nephropathy (CIN) is a leading cause of a hospital acquired renal failure and affects mortality and morbidity of patients with renal insufficiency. N-acetylcysteine and ascorbic acid have recently been reported to prevent CIN in renal insufficiency due to its antioxidant property. There has been no study comparing the efficacy for CIN between the two antioxidants.
Methods: We conducted a prospective randomized controlled trial to compare the two antioxidants. A total of 212 patients with basal renal insufficiency (creatinine clearance [CrCl] <60ml/min or serum creatinine (SCr) ≥ 1.1mg/dl) were randomize to have high-dose N-acetylcysteine (h-NAC) (1200mg orally twice a day before and on the day of coronary catheterization, n=106) or ascorbic acid (AA) (3g and 2g orally before, and 2g twice after coronary catheterization with 12hour interval, n=106). Half-isotonic saline was given intravenously at a rate of 1ml/kg/hour at least for 12hours before and 12hours after administration of contrast agent. Only iso-somolar contrast medium - iodixanol was used in coronary catheterization. The SCr was measured on day 1 and day 2 after coronary catheterization. The primary end point was the peak increase of SCr and the secondary end point was the incidence of CIN within two days. CIN was defined as an increase in SCr of either ≥ 25% or ≥ 0.5 mg/dL.
Results: There were no differences in age, sex, prevalence of diabetes, prevalence of hypertension, baseline SCr, baseline left ventricular systolic function, and contrast media dose. The mean peak increase of SCr was significantly lower in the h-NAC group: −0.029±0.18mg/dL vs. 0.036±0.20mg/mL for h-NAC vs. AA (p=0.029). The SCr decreased from 1.44mg/dL to 1.42mg/dL in the h-NAC group but did not reach statistical significance (p=0.157) and increased from 1.29mg/dL to 1.33mg/dL in the AA group with no significance (p=0.093). The incidence of CIN was less frequent in the h-NAC group (1.2% vs. 4.4% for h-NAC vs. AA) but this was not statistically significant (p=0.37).
Conclusion: In our first comparison of two antioxidants for their preventive effect of CIN, we found that high-dose N-acetylcysteine may be more beneficial than ascorbic acid in renal insufficiency patients undergoing coronary angiography.