Constast media: chronic renal insufficiency: acetylcysteine reduces acute reductions in renal function

Clinical bottom line (level 1b)

  1. Patients with chronic renal insufficiency who received acetylcysteine and saline compared with placebo and saline were less likely to develop an acute reduction in renal function (NN T = 5 at 2 days) .
  2. Patients given acetylcysteine had a smaller change in serum creatinine levels (on average 50 micromol less).
Tepel et al: New England Journal of Medicine 2000; 343 : 180-184
Expires June 2004

The study

Single-blinded ?concealed randomised trial with intention-to-treat
Setting: university hospital, Germany

83 patients (aged mean 65, 57% male) with chronic renal insufficiency (serum creatinine > 106 micromol/l; mean 216 +/- 116 micromol/l) undergoing elective computed tomography with 75 ml of iopromide, a non-ionic low-osmolality contrast agent.

Excluded if
  • acute renal failure
  • unstable serum creatinine

    Control Group: (n = 42, 42 analysed): placebo and saline infusion, before and after administration of contrast
    Experimental Group: (n = 41, 41 analysed): acetylcysteine 600 mg orally twice daily and 0.45% saline iv 1 ml/kg/hr for 12 hours, before and after admininstration of constrast for 2 days
    Patients were encouraged to drink if they felt thirsty. No patient received theophylline, dopamine, mannitol or furosemide during the study.
    100% followed for 2 days
    Outcome notes:
    • acute reduction in renal function :

    The evidence

    Outcome Time to outcome CER EER RRR
    (95% CI)    		 ARR
    (95% CI)    		 NN T
    (95% CI)
    acute reduction in renal function 2 days 9
    (21.4%)    		 1
    (2.44%)    		 89%
    (14% to 98%)    		 19.0%
    (5.71% to 32.3%)    		 5
    (3 to 18)

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    chance in serum creatinine after 48 hours (g/dl) 0.2
    ()     		-0.4
    (0.4)     		0.6
    (0.4 to 0.8)

    Comments

    1. No difference in other adverse events was not between the 2 groups.
    2. No patient required dialysis.

    Citation

    1. Tepel M, Van der Giet M, Schwarzfeld C, et al: prevention of radiographic contrast agent induced reduction in renal function by acetylcysteine. New England Journal of Medicine 2000; 343 : 180-184
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    Contributor: Chris Ball, June 2001
    Reviewer:

    Clinical Question.
    Patient chronic renal insufficiency
    Intervention or Exposure acetylcysteine and saline
    Comparison placebo and saline
    Outcome worsening renal function
    		•