How should N-acetylcysteine (Mucomyst) be used prophylactically for patients who have been diagnosed with chronic renal insufficiency and are undergoing cardiac catheterization?
—Marilyn Otero, RPA-C, New York City
N-acetylcysteine is an antioxidant and scavenger of free radicals. It also enhances the biologic effect of the endogenous vasodilator nitric oxide, which in turn maintains kidney perfusion (Patient Safety Authority. Contrast-Induced Nephropathy: Can This Iatrogenic Complication of Iodinated Contrast Be Prevented? Supplementary Advisory, March 30, 2007;4:1-24). Studies of N-acetylcysteine used to prevent contrast-induced nephropathy have had mixed results, with disparities in the dosage and amount of hydration protocols. Meta-analyses have concluded that N-acetylcysteine reduces the incidence of contrast-induced nephropathy and may have a greater renal-protective effect in high-risk patients (Am J Kidney Dis. 2004;43:1-9).
In chronic renal insufficiency, N-acetylcysteine has been shown to reduce the incidence of contrast-induced nephropathy and is effective prophylactically in high-risk patients (N Engl J Med. 2000;343:180-184). N-acetylcysteine is inexpensive and has a low incidence of adverse effects. It should be used in conjunction with close monitoring of renal function and adequate hydration.
—Debra Kleinschmidt, PhD, PA (107-2)