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Article: Acetylcysteine for Prevention of Acute Deterioration of Renal Function Following Elective Coronary Angiography and Intervention: A Randomized Controlled Trial

TitleAcetylcysteine for Prevention of Acute Deterioration of Renal Function Following Elective Coronary Angiography and Intervention: A Randomized Controlled Trial
Authors
Issue Date2003
PublisherAmerican Medical Association. The Journal's web site is located at http://jama.ama-assn.org/index.dtl
Citation
Journal Of The American Medical Association, 2003, v. 289 n. 5, p. 553-558 How to Cite?
AbstractContext: The antioxidant acetylcysteine prevents acute contrast nephrotoxicity in patients with impaired renal function who undergo computed tomography scanning. However, its role in coronary angiography is unclear. Objective: To determine whether oral acetylcysteine prevents acute deterioration in renal function in patients with moderate renal insufficiency who undergo elective coronary angiography. Design and Setting: Prospective, randomized, double-blind, placebo-controlled trial conducted from May 2000 to December 2001 at the Grantham Hospital at the University of Hong Kong. Participants: Two hundred Chinese patients aged mean (SD) 68 (6.5) years with stable moderate renal insufficiency (creatinine clearance <60 mL/min [1.00 mL/s]) who were undergoing elective coronary angiography with or without intervention. Intervention: Participants were randomly assigned to receive oral acetylcysteine (600 mg twice per day; n= 102) or matching placebo tablets (n=98) on the day before and the day of angiography. All patients received low-osmolality contrast agent. Main Outcome Measures: Occurrence of more than a 25% increase in serum creatinine level within 48 hours after contrast administration; change in creatinine clearance and serum creatinine level. Results: Twelve control patients (12%) and 4 acetylcysteine patients (4%) developed a more than 25% increase in serum creatinine level within 48 hours after contrast administration (relative risk, 0.32;95% confidence interval [CI], 0.10-0.96; P=.03). Serum creatinine was lower in the acetylcysteine group (1. 22 mg/dL [107.8 μmol/L]; 95% CI, 1.11-1.33 mg/dL vs 1.38 mg/dL [122.9 μmol/L]; 95% CI, 1.27-1.49 mg/ dL; P=.006) during the first 48 hours after angiography. Acetylcysteine treatment significantly increased creatinine clearance from 44.8 mL/min (0.75 mL/s) (95% CI, 42.7-47.6 mL/min) to 58.9 mL/ min (0.98 mL/s) (95% CI, 55.6-62.3 mL/min) 2 days after the contrast administration (P<.001). The increase was not significant in the control group (from 42.1 to 44.1 mL/min [0.70 to 0.74 mL/s]; P=.15). The benefit of acetylcysteine was consistent among various patient subgroups and persistent for at least 7 days. There were no major treatment-related adverse events. Conclusion: Acetylcysteine protects patients with moderate chronic renal insufficiency from contrast-induced deterioration in renal function after coronary angiographic procedures, with minimal adverse effects and at a low cost.
Persistent Identifierhttp://hdl.handle.net/10722/162682
ISSN
2015 Impact Factor: 37.684
2015 SCImago Journal Rankings: 6.440
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorKay, Jen_US
dc.contributor.authorChow, WHen_US
dc.contributor.authorChan, TMen_US
dc.contributor.authorLo, SKen_US
dc.contributor.authorKwok, OHen_US
dc.contributor.authorYip, Aen_US
dc.contributor.authorFan, Ken_US
dc.contributor.authorLee, CHen_US
dc.contributor.authorLam, WFen_US
dc.date.accessioned2012-09-05T05:22:19Z-
dc.date.available2012-09-05T05:22:19Z-
dc.date.issued2003en_US
dc.identifier.citationJournal Of The American Medical Association, 2003, v. 289 n. 5, p. 553-558en_US
dc.identifier.issn0098-7484en_US
dc.identifier.urihttp://hdl.handle.net/10722/162682-
dc.description.abstractContext: The antioxidant acetylcysteine prevents acute contrast nephrotoxicity in patients with impaired renal function who undergo computed tomography scanning. However, its role in coronary angiography is unclear. Objective: To determine whether oral acetylcysteine prevents acute deterioration in renal function in patients with moderate renal insufficiency who undergo elective coronary angiography. Design and Setting: Prospective, randomized, double-blind, placebo-controlled trial conducted from May 2000 to December 2001 at the Grantham Hospital at the University of Hong Kong. Participants: Two hundred Chinese patients aged mean (SD) 68 (6.5) years with stable moderate renal insufficiency (creatinine clearance <60 mL/min [1.00 mL/s]) who were undergoing elective coronary angiography with or without intervention. Intervention: Participants were randomly assigned to receive oral acetylcysteine (600 mg twice per day; n= 102) or matching placebo tablets (n=98) on the day before and the day of angiography. All patients received low-osmolality contrast agent. Main Outcome Measures: Occurrence of more than a 25% increase in serum creatinine level within 48 hours after contrast administration; change in creatinine clearance and serum creatinine level. Results: Twelve control patients (12%) and 4 acetylcysteine patients (4%) developed a more than 25% increase in serum creatinine level within 48 hours after contrast administration (relative risk, 0.32;95% confidence interval [CI], 0.10-0.96; P=.03). Serum creatinine was lower in the acetylcysteine group (1. 22 mg/dL [107.8 μmol/L]; 95% CI, 1.11-1.33 mg/dL vs 1.38 mg/dL [122.9 μmol/L]; 95% CI, 1.27-1.49 mg/ dL; P=.006) during the first 48 hours after angiography. Acetylcysteine treatment significantly increased creatinine clearance from 44.8 mL/min (0.75 mL/s) (95% CI, 42.7-47.6 mL/min) to 58.9 mL/ min (0.98 mL/s) (95% CI, 55.6-62.3 mL/min) 2 days after the contrast administration (P<.001). The increase was not significant in the control group (from 42.1 to 44.1 mL/min [0.70 to 0.74 mL/s]; P=.15). The benefit of acetylcysteine was consistent among various patient subgroups and persistent for at least 7 days. There were no major treatment-related adverse events. Conclusion: Acetylcysteine protects patients with moderate chronic renal insufficiency from contrast-induced deterioration in renal function after coronary angiographic procedures, with minimal adverse effects and at a low cost.en_US
dc.languageengen_US
dc.publisherAmerican Medical Association. The Journal's web site is located at http://jama.ama-assn.org/index.dtlen_US
dc.relation.ispartofJournal of the American Medical Associationen_US
dc.titleAcetylcysteine for Prevention of Acute Deterioration of Renal Function Following Elective Coronary Angiography and Intervention: A Randomized Controlled Trialen_US
dc.typeArticleen_US
dc.identifier.emailChan, TM:dtmchan@hku.hken_US
dc.identifier.authorityChan, TM=rp00394en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1001/jama.289.5.553en_US
dc.identifier.pmid12578487-
dc.identifier.scopuseid_2-s2.0-0037419923en_US
dc.identifier.hkuros79061-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0037419923&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume289en_US
dc.identifier.issue5en_US
dc.identifier.spage553en_US
dc.identifier.epage558en_US
dc.identifier.isiWOS:000180787500025-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridKay, J=19835646800en_US
dc.identifier.scopusauthoridChow, WH=7402281062en_US
dc.identifier.scopusauthoridChan, TM=7402687700en_US
dc.identifier.scopusauthoridLo, SK=7401542391en_US
dc.identifier.scopusauthoridKwok, OH=7004955826en_US
dc.identifier.scopusauthoridYip, A=7004871382en_US
dc.identifier.scopusauthoridFan, K=7202978353en_US
dc.identifier.scopusauthoridLee, CH=7410141524en_US
dc.identifier.scopusauthoridLam, WF=19835820000en_US

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