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CLINICAL RESEARCH

N-acetylcysteine versus fenoldopam mesylate to prevent contrast agent-associated nephrotoxicity

Carlo Briguori, MD, PhD^*,,*, Antonio Colombo, MD, Flavio Airoldi, MD, Anna Violante, MD^*, Alfredo Castelli, MD, Pasquale Balestrieri, MD^*, Pietro Paolo Elia, MD^*, Bruno Golia, MD^*, Stefano Lepore, MD^*, Guido Riviezzo, MD^*, Pierfranco Scarpato, MD^*, Mariateresa Librera, MD^*, Amelia Focaccio, MD^* and Bruno Ricciardelli, MD^*

^* Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy
Laboratory of Interventional Cardiology, "Vita e Salute" University School of Medicine, Milan, Italy

Manuscript received March 11, 2004; revised manuscript received April 14, 2004, accepted April 19, 2004.

^* Reprint requests and correspondence: Dr. Carlo Briguori, Interventional Cardiology, Clinica Mediterranea, Via Orazio, 2, I-80121, Naples, Italy (Email: briguori.carlo{at}hsr.it).

OBJECTIVES: We performed a study to assess the efficacy of fenoldopam mesylate (a specific agonist of the dopamine-1 receptor) as compared with N-acetylcysteine (NAC) in preventing contrast agent-associated nephrotoxicity (CAN).

BACKGROUND: Prophylactic administration of NAC, along with hydration, prevents CAN in patients with chronic renal insufficiency who are undergoing contrast media administration. Preliminary data support the hypothesis that fenoldopam might be as effective as NAC.

METHODS: One hundred ninety-two consecutive patients with chronic renal insufficiency, referred to our institution for coronary and/or peripheral procedures, were assigned randomly to receive 0.45% saline intravenously and NAC (1,200 mg orally twice daily; NAC group; n = 97) or fenoldopam (0.10 µg/kg/min; fenoldopam group; n = 95) before and after a nonionic, iso-osmolality contrast dye administration.

RESULTS: Baseline creatinine levels were similar in the two groups: NAC group = 1.72 mg/dl (interquartile range, 1.55 to 1.90 mg/dl) and fenoldopam group = 1.75 mg/dl (interquartile range, 1.62 to 2.01 mg/dl) (p = 0.17). An increase of at least 0.5 mg/dl of the creatinine concentration 48 h after the procedure occurred in 4 of 97 patients (4.1%) in the NAC group and in 13 of 95 patients (13.7%) in the fenoldopam group (p = 0.019; odds ratio 0.27; 95% confidence interval 0.08 to 0.85). The amount of contrast media administration was similar in the two groups (NAC group = 160 ± 82 ml; fenoldopam group = 168 ± 104 ml; p = 0.54).

CONCLUSIONS: N-acetylcysteine seems to be more effective than fenoldopam in preventing CAN.

Abbreviations and Acronyms   CAN = contrast agent-associated nephrotoxicity   LVEF = left ventricular ejection fraction   NAC = N-acetylcysteine

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