A rapid protocol for the prevention of contrast-induced renal dysfunction: the RAPPID study

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