Consider The Evidence: Med/Peds Journal Roundup

July 5, 2006

N-acetylcysteine for Contrast Nephropathy Re-revisited

Filed under: Cardiology, NEJM, renal — medblog @ 10:20 am

NEJM 6/29 – The use of N-Acetylcysteine for contrast nephropathy has been so extensively studied, there are actually meta-analyses of meta-analyses on the subject. And even after all that, the evidence for N-Acetylcysteine for prevention of contrast nephropathy is still pretty much equivocal. For every study that shows a benefit, there is another that shows no benefit at all.

An article in the New England by Marenzi et al. adds weight to the pro-NAc side of the argument. The RCT specifically looked at primary angioplasty and the incidence of contrast nephropathy after the procedure. About 300 subjects were randomized to recieve Low dose NAc, high dose NAc or placebo. According to the study, there was a significant lowering of the incidence of nephropathy with the use of NAc, with the greatest effect in the high-dose group.

Although all patients were hydrated after treatment, I did not find whether the placebo group received a fluid bolus as a control for the NAc solution. Could the effect be related to the extra hydration from the medication solution rather than the NAc itself?

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February 1, 2006

Connecting GFR to Cardiovascular Outcomes: ALLHAT

Filed under: annals of internal medicine, cardiovascular, hypertension, renal — medblog @ 2:45 am

Annals 2/7 – Picking apart two frequently co-morbid diagnoses, Rahman et al. propose that low GFR is an independent predictor for CVD in hypertensive patients. In fact, patients with a moderate to severe reduction in GFR had a higher 6-year incidence of developing CHD than ESRD.

They also report that amlodipne is less effective than the diuretic chlorthalidone in preventing CHD, and lisinopril is less effective than chlorthalidone in preventing heart failure. (more…)

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