Background: Most effective strategy to prevent contrast-induced nephropathy (CIN) following cardiac catheterization is uncertain. Sodium-based hydration and N-acetylcysteine (NAC) are most commonly used. We performed a pilot study to evaluate the type of hydration and the additional benefit of ascorbic acid.
Methods: We prospectively randomized the patients at risk of CIN into three groups according to the types of preventive measures; I (n=22) N-acetylcysteine (NAC)+0.9% saline (NS), II (n=20). NAC+NS+ascorbic acid. III (n=18). NAC+sodium bicarbonate. Patients with any one of the risk factors (defined as estimated GFR <60mL/min/1.73m2, >75 year-old, history of heart failure, systolic blood pressure <90 mmHg at presentation, anemia (hematocrit, men <39%, women <36%), diabetes, history of renal failure, nephrotic syndrome, or anticipated amount of contrast dye >200 mL) were included. Patients with emergent cardiac cath, ongoing or expected dialysis, contrast agent use within 48 hours, pulmonary edema or decompensated heart failure, serum Na >145 mEq/L, or previously taking NAC, ascorbic acid or theophylline were excluded. Before and after procedure, NAC was given 1200 mg twice (total 4800 mg), NS 1 cc/kg/hr for 12 hours (total 24 hours), and ascorbic acid 3g and 4g (total 7g), respectively. Serum creatinine and cystatin C were sampled at baseline, 24 hours, 48 hours, and 3 to 5 days after procedures. CIN was defined as either increase of serum creatinine ≥ 0.5 mg/dL or ≥ 25% from baseline.
Results: A total of 60 patients were consecutively enrolled. Mean(±SD) age was 70.8±8.0 years and men were 27 (45%). Fifty one (85%) were hypertensive and 36 (60%) were diabetic. Mean serum creatinine was 1.18±0.47 mg/dL. All but one were given iso-osmolar contrast agent and the used amount was 137±74 mL. There were no significant differences in baseline characteristics between 3 groups. CIN occurred in 5 (8.6%, 2:2:1 in group I:II:III, p=1.0). All CIN appeared at 48 hours, one in 3-5 days and none at 24 hours. All CIN were detected by laboratory value only without symptom or necessity of dialysis.
Conclusion: In this prospective randomized pilot study enrolling high risk patients, there was no significant difference in CIN occurrence rate between three types of preventive measures. Further data collection and detailed analysis is required.
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