CLINICAL RESEARCH: CLINICAL TRIAL
A rapid protocol for the prevention of contrast-induced renal dysfunction: the RAPPID study
Christopher S. R. Baker, PhD, MRCP*,*,
Andrew Wragg, MRCP ,
Sanjay Kumar, MRCP*,
Rodney De Palma,
Laurence R. I. Baker, MD, FRCP and
Charles J. Knight, MD, MRCP
* Hammersmith Hospitals NHS Trust, London, United Kingdom
Barts and the London NHS Trust, London, United Kingdom
Manuscript received November 24, 2002;
revised manuscript received March 10, 2003,
accepted March 20, 2003.
* Reprint requests and correspondence: Dr. Christopher S. R. Baker, Department of Cardiology, Charing Cross Hospital, Hammersmith Hospitals NHS Trust, Fulham Palace Rd., London W6 8RF, United Kingdom.
cbaker{at}hhnt.org
OBJECTIVES: This study was designed to test a rapid protocol of intravenous acetylcysteine for prevention of radiocontrast-induced nephropathy (RCIN).
BACKGROUND: Oral acetylcysteine (NAC) may provide better prophylaxis against RCIN than intravenous (IV) hydration alone. Current protocols preclude prophylaxis of same-day or emergency patients owing to the need for prolonged pretreatment.
METHODS: We prospectively randomized 80 patients with stable renal dysfunction undergoing cardiac catheterization/intervention to a rapid protocol of IV NAC (150 mg/kg in 500 ml N/saline over 30 min immediately before contrast followed by 50 mg/kg in 500 ml N/saline over 4 h, n = 41, 67 ± 10 years, 90% men) or IV hydration (1 ml/kg/h N/saline for 12 h pre- and post-contrast, n = 39, 71 ± 8.8 years, 85% men).
RESULTS: Radiocontrast-induced nephropathy occurred in 2 of the 41 patients in the NAC group (5%) and in 8 of the 39 patients in the hydration group (21%; p = 0.045; relative risk: 0.28; 95% confidence interval 0.08 to 0.98). In the NAC group, mean serum creatinine fell from 1.85 ± 0.59 to 1.77 ± 0.73 and 1.79 ± 0.73 mg/dl 48 h and four days post-contrast (p = 0.02 and 0.023 vs. baseline, respectively). In the hydration group, serum creatinine increased from 1.75 ± 0.41 to 1.81 ± 0.6 48 h and 1.80 ± 0.50 mg/dl four days post-contrast (p = 0.99 and 0.23, respectively). NAC infusion was ceased after the bolus in three patients (7%) due to flushing, itching, or a transient rash.
CONCLUSIONS: Administration of IV NAC should be considered in all patients at risk of RCIN before contrast exposure when time constraints preclude adequate oral prophylaxis, provided the patient is able to tolerate this degree of volume loading.
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Abbreviations and Acronyms
| | BUN | = blood urea nitrogen | | IV | = intravenous | | NAC | = N-acetylcysteine | | RCIN | = radiocontrast-induced nephropathy | | SCr | = serum creatinine |
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