Combination of atorvastatin plus N-acetylcysteine versus atorvastatin alone to prevent contrast-induced nephropathy

Abstract

Introduction: Contrast-induced acute renal injury is the third leading cause of hospital-acquired acute kidney injury. Our trial aimed to compare high-dose statin versus statin plus N-acetylcysteine (NAC) to prevent contrast-induced nephropathy.

Material and methods: Randomized control trial included patients who undergoing elective percutaneous coronary intervention (PCI) at Alshifa Hospital in Gaza, the first group (statin: 50 patients) received 80 mg of atorvastatin orally once daily for 3 days. The second group (statin + NAC: 50 patients) received 80 mg of atorvastatin orally once daily for 3 days, plus NAC 1200 mg orally twice daily every 12 h for 2 days. All patients underwent measurement of serum creatinine and urea level before PCI and 2-3 days after the procedure. The primary endpoint was to compare development of contrast-induced nephropathy between the two groups.

Results: The total group comprised 100 patients: 71 male patients and 29 female patients. Mean age was 59 ±9.8 years. After intervention serum creatinine decreased from 1.02 ±0.27 mg/dl to1.01 ±0.29 mg/dl in the statin group, while it decreased from 1.08 ±0.36 mg/dl to 0.92 ±0.13 mg/dl in the statin + NAC group. The difference between the two groups was significant (p = 0.048). Also, the urea plasma level in the statin group decreased from 34.5 ±9.7 mmol/l to 30.6 ±8.7 mmol/l after PCI, while in the statin + NAC group it decreased from 36.4 ±9.9 mmol/l to 26.2 ±10.6 mmol/l; the difference between the two groups was significant (p = 0.017). Contrast-induced nephropathy was seen in 9 (18%) patients in the statin group and in 2 (4%) patients in the statin + NAC group (p = 0.025).

Conclusions: The combination of high-dose atorvastatin plus NAC compared to atorvastatin alone was associated with a significant reduction of contrast-induced nephropathy in patients undergoing PCI.

Keywords: N-acetylcysteine; atorvastatin; contrast-induced acute kidney injury.