Comparison of N-acetylcysteine and fenoldopam for preventing contrast-induced nephropathy (CAFCIN)

Tien M H Ng, Scott W. Shurmur, Mary Silver, Lindsay R. Nissen, Edward Lewis O'Leary, Richard S. Rigmaiden, Mike Cieciorka, Laura L. Porter, Beata A. Ineck, Mary E. Kline, Susan E. Puumala

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Abstract

Background: N-acetylcysteine and fenoldopam are commonly prescribed for prevention of contrast mediated nephropathy, however, comparative superiority of either agent is unknown. Methods: In a prospective, randomized, parallel-group trial, adult cardiac catheterization patients at the university and veterans' hospitals with pre-existing stable renal insufficiency were randomized to N-acetylcysteine 600 mg orally twice daily for 4 doses or fenoldopam 0.1 mcg/kg/min intravenously for a minimum of 8 h. All patients received intravenous hydration with normal saline (5% dextrose in normal saline for diabetics on insulin). Randomization was stratified for diabetes. The primary endpoint was mean change in Scr at 72 h. Secondary endpoint was the incidence of contrast-induced nephropathy (25% increase above baseline Scr or absolute increase of 0.5 mg/dL). Results: Study termination occurred after ninety-five patients (mean age 68 ± 10 years, female 25%, diabetic 42%, mean baseline Scr 1.5 ± 0.4 mg/dL) were randomized, with 84 completing follow-up (44 N-acetylcysteine, 40 fenoldopam). Overall, there were no significant differences in mean change in Scr at 72 h (N-acetylcysteine 0.20 ± 0.72 vs. fenoldopam 0.08 ± 0.48 mg/dL, p = 0.4) or incidence of contrast-induced nephropathy (N-acetylcysteine 5 vs fenoldopam 8, p = 0.4). No differences were detected in subgroup analyses for diabetes, baseline Scr > 1.7 or 2.0 mg/dL, gender, age > 70 years, or contrast volume > 150 mL. Results were similar after multivariate adjustment for diabetes, contrast volume, heart failure and gender. Conclusions: Our randomized comparison failed to demonstrate a significant difference in the abilities of N-acetylcysteine and fenoldopam to prevent the decline in renal function or the incidence of contrast-induced nephropathy during cardiac catheterization.

Original languageEnglish (US)
Pages (from-to)322-328
Number of pages7
JournalInternational Journal of Cardiology
Volume109
Issue number3
DOIs
StatePublished - May 24 2006

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Fenoldopam
Acetylcysteine
Cardiac Catheterization
Incidence
Veterans Hospitals
Random Allocation
Renal Insufficiency
Heart Failure
Insulin
Kidney
Glucose

Keywords

  • Angiography
  • Clinical trials
  • Fenoldopam
  • N-acetylcysteine
  • Nephropathy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of N-acetylcysteine and fenoldopam for preventing contrast-induced nephropathy (CAFCIN). / Ng, Tien M H; Shurmur, Scott W.; Silver, Mary; Nissen, Lindsay R.; O'Leary, Edward Lewis; Rigmaiden, Richard S.; Cieciorka, Mike; Porter, Laura L.; Ineck, Beata A.; Kline, Mary E.; Puumala, Susan E.

In: International Journal of Cardiology, Vol. 109, No. 3, 24.05.2006, p. 322-328.

Research output: Contribution to journalArticle

Ng, TMH, Shurmur, SW, Silver, M, Nissen, LR, O'Leary, EL, Rigmaiden, RS, Cieciorka, M, Porter, LL, Ineck, BA, Kline, ME & Puumala, SE 2006, 'Comparison of N-acetylcysteine and fenoldopam for preventing contrast-induced nephropathy (CAFCIN)', International Journal of Cardiology, vol. 109, no. 3, pp. 322-328. https://doi.org/10.1016/j.ijcard.2005.06.038
Ng, Tien M H ; Shurmur, Scott W. ; Silver, Mary ; Nissen, Lindsay R. ; O'Leary, Edward Lewis ; Rigmaiden, Richard S. ; Cieciorka, Mike ; Porter, Laura L. ; Ineck, Beata A. ; Kline, Mary E. ; Puumala, Susan E. / Comparison of N-acetylcysteine and fenoldopam for preventing contrast-induced nephropathy (CAFCIN). In: International Journal of Cardiology. 2006 ; Vol. 109, No. 3. pp. 322-328.
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abstract = "Background: N-acetylcysteine and fenoldopam are commonly prescribed for prevention of contrast mediated nephropathy, however, comparative superiority of either agent is unknown. Methods: In a prospective, randomized, parallel-group trial, adult cardiac catheterization patients at the university and veterans' hospitals with pre-existing stable renal insufficiency were randomized to N-acetylcysteine 600 mg orally twice daily for 4 doses or fenoldopam 0.1 mcg/kg/min intravenously for a minimum of 8 h. All patients received intravenous hydration with normal saline (5{\%} dextrose in normal saline for diabetics on insulin). Randomization was stratified for diabetes. The primary endpoint was mean change in Scr at 72 h. Secondary endpoint was the incidence of contrast-induced nephropathy (25{\%} increase above baseline Scr or absolute increase of 0.5 mg/dL). Results: Study termination occurred after ninety-five patients (mean age 68 ± 10 years, female 25{\%}, diabetic 42{\%}, mean baseline Scr 1.5 ± 0.4 mg/dL) were randomized, with 84 completing follow-up (44 N-acetylcysteine, 40 fenoldopam). Overall, there were no significant differences in mean change in Scr at 72 h (N-acetylcysteine 0.20 ± 0.72 vs. fenoldopam 0.08 ± 0.48 mg/dL, p = 0.4) or incidence of contrast-induced nephropathy (N-acetylcysteine 5 vs fenoldopam 8, p = 0.4). No differences were detected in subgroup analyses for diabetes, baseline Scr > 1.7 or 2.0 mg/dL, gender, age > 70 years, or contrast volume > 150 mL. Results were similar after multivariate adjustment for diabetes, contrast volume, heart failure and gender. Conclusions: Our randomized comparison failed to demonstrate a significant difference in the abilities of N-acetylcysteine and fenoldopam to prevent the decline in renal function or the incidence of contrast-induced nephropathy during cardiac catheterization.",
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AU - Ng, Tien M H

AU - Shurmur, Scott W.

AU - Silver, Mary

AU - Nissen, Lindsay R.

AU - O'Leary, Edward Lewis

AU - Rigmaiden, Richard S.

AU - Cieciorka, Mike

AU - Porter, Laura L.

AU - Ineck, Beata A.

AU - Kline, Mary E.

AU - Puumala, Susan E.

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N2 - Background: N-acetylcysteine and fenoldopam are commonly prescribed for prevention of contrast mediated nephropathy, however, comparative superiority of either agent is unknown. Methods: In a prospective, randomized, parallel-group trial, adult cardiac catheterization patients at the university and veterans' hospitals with pre-existing stable renal insufficiency were randomized to N-acetylcysteine 600 mg orally twice daily for 4 doses or fenoldopam 0.1 mcg/kg/min intravenously for a minimum of 8 h. All patients received intravenous hydration with normal saline (5% dextrose in normal saline for diabetics on insulin). Randomization was stratified for diabetes. The primary endpoint was mean change in Scr at 72 h. Secondary endpoint was the incidence of contrast-induced nephropathy (25% increase above baseline Scr or absolute increase of 0.5 mg/dL). Results: Study termination occurred after ninety-five patients (mean age 68 ± 10 years, female 25%, diabetic 42%, mean baseline Scr 1.5 ± 0.4 mg/dL) were randomized, with 84 completing follow-up (44 N-acetylcysteine, 40 fenoldopam). Overall, there were no significant differences in mean change in Scr at 72 h (N-acetylcysteine 0.20 ± 0.72 vs. fenoldopam 0.08 ± 0.48 mg/dL, p = 0.4) or incidence of contrast-induced nephropathy (N-acetylcysteine 5 vs fenoldopam 8, p = 0.4). No differences were detected in subgroup analyses for diabetes, baseline Scr > 1.7 or 2.0 mg/dL, gender, age > 70 years, or contrast volume > 150 mL. Results were similar after multivariate adjustment for diabetes, contrast volume, heart failure and gender. Conclusions: Our randomized comparison failed to demonstrate a significant difference in the abilities of N-acetylcysteine and fenoldopam to prevent the decline in renal function or the incidence of contrast-induced nephropathy during cardiac catheterization.

AB - Background: N-acetylcysteine and fenoldopam are commonly prescribed for prevention of contrast mediated nephropathy, however, comparative superiority of either agent is unknown. Methods: In a prospective, randomized, parallel-group trial, adult cardiac catheterization patients at the university and veterans' hospitals with pre-existing stable renal insufficiency were randomized to N-acetylcysteine 600 mg orally twice daily for 4 doses or fenoldopam 0.1 mcg/kg/min intravenously for a minimum of 8 h. All patients received intravenous hydration with normal saline (5% dextrose in normal saline for diabetics on insulin). Randomization was stratified for diabetes. The primary endpoint was mean change in Scr at 72 h. Secondary endpoint was the incidence of contrast-induced nephropathy (25% increase above baseline Scr or absolute increase of 0.5 mg/dL). Results: Study termination occurred after ninety-five patients (mean age 68 ± 10 years, female 25%, diabetic 42%, mean baseline Scr 1.5 ± 0.4 mg/dL) were randomized, with 84 completing follow-up (44 N-acetylcysteine, 40 fenoldopam). Overall, there were no significant differences in mean change in Scr at 72 h (N-acetylcysteine 0.20 ± 0.72 vs. fenoldopam 0.08 ± 0.48 mg/dL, p = 0.4) or incidence of contrast-induced nephropathy (N-acetylcysteine 5 vs fenoldopam 8, p = 0.4). No differences were detected in subgroup analyses for diabetes, baseline Scr > 1.7 or 2.0 mg/dL, gender, age > 70 years, or contrast volume > 150 mL. Results were similar after multivariate adjustment for diabetes, contrast volume, heart failure and gender. Conclusions: Our randomized comparison failed to demonstrate a significant difference in the abilities of N-acetylcysteine and fenoldopam to prevent the decline in renal function or the incidence of contrast-induced nephropathy during cardiac catheterization.

KW - Angiography

KW - Clinical trials

KW - Fenoldopam

KW - N-acetylcysteine

KW - Nephropathy

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