N-acetylcysteine in the prevention of contrast agent-induced nephrotoxicity in patients undergoing computed tomography studies

Background: Renal toxicity of contrast media remains an ever-present challenge. Contrast agent-induced nephrotoxicity (CIN) is defined as a serum creatinine rise of at least 25% from baseline, 48–72 h after contrast-agent infusion. It is suggested that prophylactic administration of N-acetylcysteine 600 mg orally twice daily for 2 days along with hydration prevents CIN, 48 h after contrast-agent administration in patients undergoing coronary or peripheral angiography. Aims: This study was designed to evaluate the efficacy of N-acetylcysteine 1200 mg once-daily oral administration on the day before and the day of imaging for the prevention of CIN during a 72 h follow-up of patients receiving contrast agents for abdominal and chest computed tomography (CT) scanning. Methods: A total of 70 patients with renal insufficiency (serum creatinine level ≥1.2 mg/dl) who referred to our institution for abdominal or chest CT scanning were randomly assigned to receive either only normal saline before contrast-agent administration (control group) or normal saline plus N-acetylcysteine 1200 mg single daily oral dose on the day before imaging and at the day of contrast-agent injection (N-acetylcysteine group). Both groups were comparable in terms of demographics, disease states, drug regimens, risk factors for developing CIN, type of imaging and type, volume or concentration of contrast agent used. Results: A total of 70 patients (35 per group) completed the study. The mean of serum creatinine concentrations were increased over 72 h follow-up in both groups; however, the change in serum creatinine level was greater in the control than the N-acetylcysteine group (p < 0.001). The percentage of patients who experienced CIN was significantly greater in the control group (34.3%) than in the N-acetylcysteine group (14.3%; p = 0.05). Conclusion: Prophylactic oral administration of N-acetylcysteine 1200 mg once daily for 2 days, combined with intravenous hydration, reduced the rise in serum creatinine levels over 48–72 h after the administration of the contrast agent in patients undergoing CT studies.