The impact of N-acetylcysteine and ascorbic acid in contrast-induced nephropathy in critical care patients: an open-label randomized controlled study

Autor: Epaminondas Zakynthinos, Demosthenes Makris, Grigorios Garoufalis, Eleni Palli, John Papanikolaou, Paris Zygoulis, Irini Tsilioni
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Male
Contrast Media
030204 cardiovascular system & hematology
Critical Care and Intensive Care Medicine
Kidney
Gastroenterology
Blood Urea Nitrogen
chemistry.chemical_compound
0302 clinical medicine
Interquartile range
Prospective Studies
Greece
lcsh:Medical emergencies. Critical care. Intensive care. First aid
Acute Kidney Injury
Middle Aged
Intensive Care Units
Creatinine
Ascorbic acid
Administration
Intravenous
Female
medicine.medical_specialty
Critical Care
Contrast-induced nephropathy
Renal function
Statistics
Nonparametric
Nephrotoxicity
Nephropathy
03 medical and health sciences
Contrast induced nephropathy
Internal medicine
Intensive care
medicine
Humans
cystatin-C
business.industry
Research
030208 emergency & critical care medicine
lcsh:RC86-88.9
medicine.disease
N-acetylcysteine
Surgery
Acetylcysteine
8-Isoprostane
chemistry
ROC Curve
Multivariate Analysis
business
Tomography
X-Ray Computed
Zdroj: Critical Care, Vol 21, Iss 1, Pp 1-9 (2017)
Critical Care
ISSN: 1364-8535
Popis: Background The aim was to investigate whether the use of N-acetylcysteine and ascorbic acid reduce contrast-induced nephropathy incidence in critical care patients. Methods This was a one-center, two-arm, prospective, randomized, open-label, controlled trial in the Intensive Care Unit of the University Hospital of Larissa, Greece. Patients with stable renal function, who underwent non urgent contrast-enhanced computed tomography for diagnostic purposes, were included in the study. Patients in the treatment group (NacA, n = 60) received intravenously N-acetylcysteine (1200 mg) and ascorbic acid (2 g) dissolved separately in 100 ml of normal saline 2 hours before, and at 10 hours and 18 hours following the infusion of contrast agent, while control group patients (CG, n = 64) received only normal saline. All patients received additional hydration. Contrast-induced nephropathy was defined as relative increase by 25% of the baseline values of serum creatinine. Results Contrast-induced nephropathy in NacA and CG were 18.33% and 15.6%, respectively (p = 0.81). The percentage change median (interquartile range (IR)) of serum cystatin-C (mg/L) from baseline in patients who underwent contrast-induced tomography, were 37.23% (28.53) and 93.20% (46.90) in NacA and in CG, respectively (p = 0.03). The 8-isoprostane serum levels in NacA were significantly lower compared to CG at 2 hours (p = 0.012) and 24 hours (p = 0.006) following radiocontrast infusion. Multivariate analysis revealed that contrast-induced nephropathy was independently associated with a higher baseline ratio of serum urea/creatinine (odds ratio, 1.02; 95 CI%, 1.00–1.05) and with the use of nephrotoxic medications (odds ratio, 0.24; 95 CI%, 0.06–0.94). Conclusion Intravenous administration of N-acetylcysteine and ascorbic acid failed to reduce contrast-induced nephropathy in critically ill patients who underwent contrast-enhanced computed tomography, despite a significant reduction of 8-isoprostane levels in treated patients. Trial registration ClinicalTrials.gov, NCT01017796. Registered on 20 November 2009. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1862-3) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
Externí odkaz: