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- Title
Improved estimation of glomerular filtration rate by serum cystatin C in preventing contrast induced nephropathy by N-acetylcysteine or zinc--preliminary results.
- Authors
Martin Kimmel; Moritz Butscheid; Stefanie Brenner; Ulrich Kuhlmann; Ulrich Klotz; Dominik Mark Alscher
- Abstract
Background. Prevention of contrast media (CM) induced nephropathy (CIN) by prophylaxis (e.g. N-acetylcysteine; NAC) is controversially discussed. Up to now, assessment of kidney function has been based on measurements of serum creatinine, although this biomarker has several limitations. We investigated NAC and zinc (Zn) for the prevention of CIN by monitoring creatinine and cystatin C. Methods. In a prospective, placebo-controlled, double blind trial, patients with moderately impaired kidney function receiving low-osmolar, non-ionic CM were randomly assigned to an oral treatment for 2 days with 1.2 g/day of NAC (n = 19), for 1 day with 60 mg/day of Zn (n = 18) or placebo (n = 17). All patients received peri-procedurally 1âml/kg/h of 0.45% saline for 24 h. At baseline, prior to exposure of CM, 2 and 6 days after CM, creatinine and cystatin C were measured. Results. There was no difference in the incidence of CIN, but a significant drop in creatinine (P P = 0.012) and the placebo (P = 0.041) group, whereas NAC prevented this deterioration of kidney function. Conclusions. Cystatin C seems to reflect CM-induced changes in kidney function better than creatinine. NAC and Zn have no effect in preventing CIN by the standard definition, but based on cystatin C we can confirm a preventive effect of NAC. It appears mandatory to assess kidney function by cystatin C in CIN intervention trials, because relying on creatinine can be misleading.
- Subjects
BLOOD plasma; BLOOD; SERUM; BLOOD plasma substitutes
- Publication
Nephrology Dialysis Transplantation, 2008, Vol 23, Issue 4, p1241
- ISSN
0931-0509
- Publication type
Article