Does Ultra-High Dose i.v. N-acetylcysteine Prevent Contrast Nephropathy in Patients With Chronic Kidney Disease Undergoing Emergency Contrast Tomography.

Prevention of acute kidney injury (AKI) post contrast injection remains mandatory given its association to morbidity and mortality1.

Contrast nephropathy (CN) was classically defined as an increase in 25% or more or absolute increase of 44 umol/l of creatinine levels within three days following contrast injection2. Markers such as cystatine C may be more sensitive to identify CN and also to correlate to mortality8 although a definition of CN using these markers is lacking.

In patients undergoing elective radiological procedures, CN can be prevented by hydration, withdrawal of diuretics and nephrotoxic drugs. N Acetylcysteine (NAC) has been proposed to protect against contrast nephropathy since 200013. While hydratation is clearly beneficial in preventing CIN14, the role of NAC administration is still uncertain and results of RCTs gave conflicting results regarding its effect15.

Intravenous N-acetylcysteine (NAC) may be the form of choice in emergency procedures given its rapid disponibility and its ease of administration in patients whose consciousness is altered or who can not eat.

The aim of the present study is therefore to determine whether 6000 mg of intravenous NAC is efficient in preventing CN after emergency contrast injection in CKD patients.