Study of combination of ascorbic acid and N-acetylcysteine in prevention of contrast induced nephropathy in patients with moderate renal insufficiency

ABSTRACT

Introduction and aims: Despite fluid administration is the most effective strategy in contrast induced nephropathy (CIN) prevention, still the estimated prevalence of CIN up to 50% in high-risk patients. There is still a great debate as regarding the administration of antioxidants in reduction of CIN incidence. This study aims to determine whether addition of ascorbic acid to IV acetylcysteine could reduce CIN prevalence in patients with moderate chronic kidney disease.

Methods: We conducted prospective, randomized, double blind, placebo-controlled trial on 106 patients scheduled for elective coronary or aorto-iliac angiography. The patients were divided in two groups: Group 1 (n = 53) receive hydration and placebo while Group 2 (n = 53), received IV 1200mg acetylcysteine , 2g ascorbic acid and hydration before and after the procedure. Occurrence of more than a 25% increase in serum creatinine level within 5 days after contrast administration considered as CIN.

Results: The incidence of CIN was significantly lower in Group 2 (3.7%) compared with Group 1 (12%) p=0.02. A lower average serum creatinine (P= 0.01) and a higher average creatinine clearance was found in Group 2 after 5 days of contrast administration (P= 0.01). Patients receiving placebo had a longer hospital stay than patients receiving a combination of NAC and ascorbic acid (p<0.02).

Conclusion: In our study, prophylactic oral administration of the antioxidant ascorbic acid in addition to high dose IV N-acetylcysteine diminish the incidence of CIN in patients with moderate CKD with minimal adverse effects and at a low cost.

Key words:  Ascorbic acid; N-Acetylcysteine; Contrast Nephropathy; Moderate CKD.

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