Prophylaxis of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography Briain D. MacNeill, Scott A. Harding, Hasan Bazari, MD, Kristen K. Patton, MD, Pedro Colon-Hernadez, MD, Denise deJoseph, and Ik-Kyung Jang, * MD, PhD Contrast-induced nephropathy (CIN) is a common complication of cardiac catheteriza- tion, reported to result in a 15% incidence of acute renal failure. Convincing evidence supports the prophylactic use of prehydration and low volumes of contrast medium. Recently, the antioxidant acetylcysteine has been shown to have a potential preventive role. The aim of this study was to examine the hypothesis that acetylcysteine prevents CIN. Patients undergoing cardiac catheterization with a serum creatinine ≥ 1.5 mg/dl were prospectively randomized to receive acetylcysteine or placebo. A total of five doses of acetylcysteine 600 mg b.i.d. or placebo was administered, commencing on the day of the procedure. All patients were prehydrated with 0.45% saline and during the catheter- ization a nonionic low-osmolality contrast medium was used. Serum creatinine and urea were measured at 24, 48, and 72 hr postprocedure. A total of 43 patients were studied. There was no significant difference between the groups in terms of baseline character- istics, including baseline renal function. No adverse events were experienced with ace- tylcysteine treatment. Serum creatinine levels at 48 and 72 hr remained largely un- changed in the acetylcysteine group but continued to rise at 48 and 72 hr in the placebo group. By 72 hr, the incidence of CIN, defined as a 25% increase in baseline creatinine, was significantly lower in the acetylcysteine arm compared to placebo (5% for acetyl- cysteine vs. 32% for placebo; P  0.046). In patients with mild to moderate renal impairment undergoing cardiac catheterization, prophylactic treatment with oral acetyl- cysteine reduces the incidence of contrast-induced nephropathy. Catheter Cardiovasc Interv 2003;60:458 – 461. © 2003 Wiley-Liss, Inc. Key words: acetylcysteine; contrast nephropathy; cardiac catheterization; nephropathy INTRODUCTION Contrast-induced nephropathy (CIN) has become the third most common cause of new onset renal failure in hospitalized patients, resulting in a 14.5% incidence of acute renal failure in unselected patients undergoing cardiac catheterization [1]. The develop- ment of CIN increases morbidity, mortality, length of hospital stay, health care costs, and can lead to end-stage renal failure [2]. Interventional cardiol- ogy is entering a new era characterized by older pa- tient populations with higher rates of comorbidity, complex lesion angioplasty, and multivessel interven- tion. Each of these features is likely to increase the incidence of CIN, rendering the significance of this iatrogenic condition profound. Clearly, methods to prevent or ameliorate this common complication are urgently needed. To date, successful strategies in preventing CIN have included prehydration and the use of low-osmolality con- trast agents. Recently, the antioxidant acetylcysteine was hypothesized to inhibit cytokine production and oxygen free radical release purported to mediate tissue injury in CIN. As such, acetylcysteine proved successful in reduc- ing the incidence of CIN in patients undergoing comput- erized tomography (CT) requiring a fixed volume (75 ml) of low-osmolality contrast [3]. Greater contrast exposure and concomitant peripheral atherosclerosis, including re- novascular disease, precludes extrapolation of these re- sults into cardiology practice. Several studies have shown conflicting results with prolonged regimes of pre- hydration and acetylcysteine therapy [4 –9]. We sought therefore to clarify if the prophylactic use of acetylcys- teine would prevent or reduce the incidence of CIN in Cardiology Division, Massachusetts General Hospital and Har- vard Medical School, Boston, Massachusetts *Correspondence to: Dr. Ik-Kyung Jang, Cardiology Division, Mas- sachusetts General Hospital, 55 Fruit Street, Gray/Bigelow 800, Bos- ton, MA 02114. E-mail: jang.ik@mgh.harvard.edu Received 7 February 2003; Revision accepted 5 August 2003 DOI 10.1002/ccd.10684 Published online in Wiley InterScience (www.interscience.wiley.com). Catheterization and Cardiovascular Interventions 60:458 – 461 (2003) © 2003 Wiley-Liss, Inc.