Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine

Background: Radiographic contrast agents can cause a reduction in renal fun ction that may be due to reactive oxygen species. Whether the reduction can be prevented by the administration of antioxidants is unknown. Methods: We prospectively studied 83 patients with chronic renal insufficie ncy (mean [+/-SD] serum creatinine concentration, 2.4+/-1.3 mg per decilite r [216+/- 116 mu mol per liter]) who were undergoing computed tomography wi th iopromide, a nonionic, low-osmolality contrast agent. Patients were rand omly assigned either to receive the antioxidant acetylcysteine (600 mg oral ly twice daily) and 0.45 percent saline intravenously, before and after adm inistration of the contrast agent, or to receive placebo and saline. Results: Ten of the 83 patients (12 percent) had an increase of at least 0. 5 mg per deciliter (44 mu mol per liter) in the serum creatinine concentrat ion 48 hours after administration of the contrast agent: 1 of the 41 patien ts in the acetylcysteine group (2 percent) and 9 of the 42 patients in the control group (21 percent; P=0.01; relative risk, 0.1; 95 percent confidenc e interval, 0.02 to 0.9). In the acetylcysteine group, the mean serum creat inine concentration decreased significantly (P<0.001), from 2.5+/-1.3 to 2. 1+/-1.3 mg per deciliter (220+/-118 to 186+/-112 mu mol per liter) 48 hours after the administration of the contrast medium, whereas in the control gr oup, the mean serum creatinine concentration increased nonsignificantly (P= 0.18), from 2.4+/-1.3 to 2.6+/-1.5 mg per deciliter (212+/-114 to 226+/-133 mu mol per liter) (P<0.001 for the comparison between groups). Conclusions: Prophylactic oral administration of the antioxidant acetylcyst eine, along with hydration, prevents the reduction in renal function induce d by iopromide, a nonionic, low-osmolality contrast agent, in patients with chronic renal insufficiency. (N Engl J Med 2000;343:180-4.) (C)2000, Massa chusetts Medical Society.