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N-acetylcysteine for radiocontrast-induced nephropathy: Potential role in the emergency department?

Published online by Cambridge University Press:  21 May 2015

Elaine Chong  and
Peter J. Zed
Elaine Chong
Affiliation:
Clinical Services, Virtual Learning Inc., Toronto, Ont.
Peter J. Zed*
Affiliation:
CSU Pharmaceutical Sciences, Vancouver General Hospital, Faculty of Pharmaceutical Sciences & Associate Member, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC.
*
CSU Pharmaceutical Sciences, Vancouver General Hospital, 855 West 12th Ave., Vancouver BC V5Z 1M9; 604 875-4077, fax 604 875-5267, zed@interchange.ubc.ca

Abstract

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Objective:

To systematically review the efficacy and safety of N-acetylcysteine (NAC) for the prevention of radiocontrast-induced nephropathy (RIN), and to discuss its potential role in the emergency department.

Methodology:

We conducted a search of MEDLINE (from 1966 to December 2003), PubMed (1966 to December 2003) and EMBASE (1988 to December 2003) for English-language, prospective, randomized, controlled trials in humans using the search terms N-acetylcysteine, acetylcysteine, radiopharmaceuticals, contrast media, and kidney failure (acute).

Results:

Five trials support and 4 trials refute the hypothesis that NAC helps prevent RIN. In 7 of 9 trials, oral NAC was administered twice daily for 2 days, on the day before and on the day of the radiocontrast study — a regime not feasible for emergent situations. More recent trials suggest that adequate hydration and lower volumes of radiocontrast, rather than NAC, are more effective ways to prevent RIN.

Conclusion:

Although further study may be indicated, current evidence does not suggest that NAC has a role in the emergency prevention of RIN.

Keywords

N-acetylcysteineradiocontrastemergencyrenal failurenephropathy
Type
Pharmacotherapy • Pharmacothérapie
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 4 , July 2004 , pp. 253 - 258
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

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