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KMID : 1013220170150020122
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Jouranl of the Korean Society of Clinical Toxicology
2017 Volume.15 No. 2 p.122 ~ p.130
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Low-dose Intravenous N-acetylcysteine for the Prevention of Contrast-Induced Nephropathy in Emergency Patients Undergoing Computed Tomography
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Lee Tae-Wan
Kim Ji-Hoon
Choi Seung-Phill
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Abstract
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Objective: To evaluate the effect of low-dose intravenous N-acetylcysteine on prevention of contrast-induced nephropathy (CIN) in patients undergoing computed tomography (CT).
Method: This retrospective cohort study enrolled all adult patients presenting to an emergency department and undergoing CT with intravenous contrast media from August 2014 to April 2016. We included hospitalized patients with renal dysfunction [estimated glomerular fitration rate (GFR) between 30 and 89 mL/min/1.73m2]. A 600-mg injection of N-acetylcysteine before and the other immediately after CT was given to patients, depending on physicians’ preferences. The primary outcome was CIN defined as an increase in creatinine level of ≥25% or ≥0.5mg/dL from baseline within 48 to 72 hours after CT. A trained person blindly reviewed all medical records.
Results: Of 1903 admitted patients, CIN occurred in 9.8% of patients who received 1200mg intravenous N-acetylcysteine (24/244) and 6.8% of patients who did not (113/1659, p=0.090). In multivariable regression analysis, N-acetylcystine was not relevant to the prevention of CIN (odds ratio = 1.42 [95% CI, 0.90-2.26]). Even in the stratified analysis using the propensity score matching, N-acetylcysteine was irrelevant (GFR 30-59: odds ratio = 1.06 [95% CI, 0.43-2.60]; GFR 60-89: odds ratio = 1.76 [95% CI, 0.75-4.14]). After adjustment, crystalloids were significantly associated with reduction in CIN compared with dextrose water (odds ratio = 0.60 [95% CI, 0.37-0.97]).
Conclusions: No effect was found when low-dose intravenous N-acetylcysteine was used to prevent CIN. However, there is an association between crystalloids and reduction in CIN.
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KEYWORD
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Acute kidney injury, Contrast media, N-acetylcysteine
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