Prevention of contrast-induced nephropathy by N -acetylcysteine in critically ill patients: Different definitions, different results

• Published in: Journal of critical care Vol. 28; no. 5; pp. 701 - 709
• Main Authors: Chousterman, Benjamin G., MD, MSc, Bouadma, Lila, MD, PhD, Moutereau, Stephane, MD, PhD, Loric, Sylvain, MD, PhD, Alvarez-Gonzalez, Antonio, MD, Mekontso-Dessap, Armand, MD, PhD, Laissy, Jean-Pierre, MD, PhD, Rahmouni, Alain, MD, PhD, Katsahian, Sandrine, MD, PhD, Brochard, Laurent, MD, PhD, Schortgen, Frédérique, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2013; Elsevier Limited
• Subjects: Acetylcysteine - therapeutic use; Acute kidney injury; Adult; Aged; Contrast agents; Contrast media; Contrast Media - adverse effects; Creatinine - blood; Critical Care; Critical Illness; Cystatin C; Cystatin C - blood; Diabetes; Enzymes; Female; Free Radical Scavengers - therapeutic use; Hospitalization; Humans; Hydration; ICU; Intensive care; Iohexol - adverse effects; Kidney Diseases - chemically induced; Kidney Diseases - prevention & control; Kidney Function Tests; Male; Middle Aged; Mortality; N-acetycysteine; Patients; Prospective Studies; Respiratory distress syndrome; Treatment Outcome; France; ICU; N-acetycysteine; Acute kidney injury; Contrast media; Cystatin C
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2013.03.007

Abstract Purpose The use of N -acetylcysteine (NAC) for preventing contrast induced nephropathy (CIN) is debated in the intensive care unit. NAC may alter the concentration of serum creatinine and interfere with CIN diagnosis. The effectiveness of NAC was evaluated with a special attention on its specific effect on creatinine levels compared to cystatin C. Methods In a first period, we prospectively enrolled patients receiving saline and low osmolality contrast media for 140 exams in 2 intensive care units with opposite policies regarding the use of NAC. Renal impairment was defined by both the classical CIN and the “sensitive” Acute Kidney Injury Network (AKIN) (taking creatinine and diuresis) definitions. In a second period, we compared the evolution of serum creatinine and cystatin C after 23 additional contrast examinations under NAC. Results Seventy exams with and without NAC were compared in the first period. Risk factors for CIN were similar in the two intensive care unit populations. No difference in CIN incidence was found with and without NAC, using the CIN (10/70 vs 15/70) or the AKIN (24/70 vs 22/70) definition. Interestingly, NAC seemed to reduce renal impairment when the creatinine criterion of the AKIN definition was considered alone [9% vs 21%, P = .033]. Overall, the incidence of renal impairment was 18%, 33% and 15% using the CIN definition, the AKIN, or using AKIN with creatinine alone. Serum creatinine significantly decreased after exams with NAC while cystatin C remained stable. Conclusion The incidence of CIN does not seem to be influenced by NAC, except if small changes in creatinine only are considered.