Modeling Zinc Intake for Intervention and Scenario Analysis.

BACKGROUND: A large number of illnesses, afflicting one-third of the world's population, have been attributed to zinc deficiency. Inadequate dietary intake of bioavailable forms of zinc is considered the most frequent cause of zinc deficiency, which is most common in arid regions of developing countries. OBJECTIVE: To employ a modeling approach in a test population to analyze how best to eliminate zinc deficiency using different plausible dietary scenarios. METHODS: A comprehensive database was built upon food consumption patterns of two population groups residing in a village and a suburb in semiarid central Iran near Isfahan city. A database was created on zinc and phytic acid concentrations of different foods and ingredients consumed by the study populations. A zinc intake model was constructed and parameterized accounting for bioavailability and model input uncertainties. RESULTS: The zinc intake of about one-third of both study populations, which did not differ significantly in their rates of zinc deficiency, was below the Estimated Average Requirement (EAR) for zinc. Scenario analyses predicted that at the current rate of food consumption, it would take up to 60 years for 97.5% of the population to meet their zinc EARs. Fortification of wheat flour and biofortification of wheat grains would result in 93% and 88% of the population, respectively, achieving their EARs in 15 years. CONCLUSIONS: The modeled results suggest that fortification and biofortification are the most effective and sustainable strategies to combat zinc deficiency. The methodology developed in this study is general and is shown to be a useful tool for the analysis of possible future trends and intervention scenarios.

Arsenic pollution of groundwater in Vietnam exacerbated by deep aquifer exploitation for more than a century.

Arsenic contamination of shallow groundwater is among the biggest health threats in the developing world. Targeting uncontaminated deep aquifers is a popular mitigation option although its long-term impact remains unknown. Here we present the alarming results of a large-scale groundwater survey covering the entire Red River Delta and a unique probability model based on three-dimensional Quaternary geology. Our unprecedented dataset reveals that ∼7 million delta inhabitants use groundwater contaminated with toxic elements, including manganese, selenium, and barium. Depth-resolved probabilities and arsenic concentrations indicate drawdown of arsenic-enriched waters from Holocene aquifers to naturally uncontaminated Pleistocene aquifers as a result of > 100 years of groundwater abstraction. Vertical arsenic migration induced by large-scale pumping from deep aquifers has been discussed to occur elsewhere, but has never been shown to occur at the scale seen here. The present situation in the Red River Delta is a warning for other As-affected regions where groundwater is extensively pumped from uncontaminated aquifers underlying high arsenic aquifers or zones.

A high-resolution assessment on global nitrogen flows in cropland.

Crop production is the single largest cause of human alteration of the global nitrogen cycle. We present a comprehensive assessment of global nitrogen flows in cropland for the year 2000 with a spatial resolution of 5 arc-minutes. We calculated a total nitrogen input (IN) of 136.60 trillion grams (Tg) of N per year, of which almost half is contributed by mineral nitrogen fertilizers, and a total nitrogen output (OUT) of 148.14 Tg of N per year, of which 55% is uptake by harvested crops and crop residues. We present high-resolution maps quantifying the spatial distribution of nitrogen IN and OUT flows, soil nitrogen balance, and surface nitrogen balance. The high-resolution data are aggregated at the national level on a per capita basis to assess nitrogen stress levels. The results show that almost 80% of African countries are confronted with nitrogen scarcity or nitrogen stress problems, which, along with poverty, cause food insecurity and malnutrition. The assessment also shows a global average nitrogen recovery rate of 59%, indicating that nearly two-fifths of nitrogen inputs are lost in ecosystems. More effective management of nitrogen is essential to reduce the deleterious environmental consequences.

Renal Function following Fluorescein Angiography in Diabetic Patients with Chronic Kidney Disease.

Purpose: To evaluate the effect of fluorescein dye usage on renal function in patients with diabetic retinopathy (DR) and chronic kidney disease (CKD). Methods: Diabetic patients with retinopathy who were candidate for fundus fluorescein angiography (FA) were evaluated for serum creatinine and urea levels within five days prior to performing the FA. Serum creatinine levels of 1.5 mg/dl or more in males and 1.4 mg/dl or more in females were both identified as CKD and were included in the study. An increase of 0.5 mg/dl or 25% in creatinine after FA was considered as contrast-induced acute kidney injury (AKI). Estimated glomerular filtration rate (eGFR) was also calculated for all patients using a CKD-Epi formula. CKD grading was determined based on eGFR values. Results: Forty-two patients agreed to participate, of which 23 (54.8%) were male. Seventeen patients were identified with grade 3a or lower CKD, 12 with grade 3b, 11 with grade 4, and two with grade 5 CKD. Considering all grades of CKD, the mean blood urea before and after angiography was 58.48 ± 26.7 and 57 ± 27.81 mg/dl, respectively (P = 0.475). The mean serum creatinine before and after the test was 1.89 ± 1.04 and 1.87±0.99 mg/dl, respectively (P = 0.993). The mean eGFR before and after the test was 44.024 ± 23.5447 and 43.850 ± 21.8581 mL/min/1.73 m2 (P = 0.875). Conclusion: According to the findings of this study, FA does not seem to further deteriorate kidney function in patients with diabetic associated CKD.

Environmental selenium research: from microscopic processes to global understanding.

Selenium is a natural trace element that is of fundamental importance to human health. The extreme geographical variation in selenium concentrations in soils and food crops has resulted in significant health problems related to deficient or excess levels of selenium in the environment. To deal with these kinds of problems in the future it is essential to get a better understanding of the processes that control the global distribution of selenium. The recent development of analytical techniques and methods enables accurate selenium measurements of environmental concentrations, which will lead to a better understanding of biogeochemical processes. This improved understanding may enable us to predict the distribution of selenium in areas where this is currently unknown. These predictions are essential to prevent future Se health hazards in a world that is increasingly affected by human activities.

Association of overtime urine volume and ultrafiltration changes with patient survival in continuous ambulatory peritoneal dialysis patients.

BACKGROUND: Associations between patient survival and baseline urine volume (UV), ultrafiltration (UF) volume, and combined UV and UF were evaluated in Iranian continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: From 1995 to 2006, data on 1472 CAPD patients from 26 centers were collected. Demographic, clinical, and laboratory characteristics were analyzed using STATA software. Baseline UV was considered as an indicator of residual renal function and patients with an annual decrease of more than 250 cc/day were placed in decreasing UV group. The role of a new variable, net positive fluid removal, which defines as the combination of baseline UV and UF, was also evaluated. RESULTS: Patients with higher baseline UV were significantly more married and educated and candidate for CAPD based on positive selection criteria. In dichotomous categorization, mean of serum creatinine was lower and albumin was higher in patients with UV ≥ 1000 cc/day compared with UV < 250 cc/day. A significant correlation was found between baseline UV <250 cc/day and ≥1000 cc/day and patient survival. Patients with stable UV had better survival compared with patients with decreasing UV (p = 0.04). There was no correlation between UF and patient survival. Remarkable association with patient and technique survival and net positive fluid removal ≥2000 cc/day and <500 cc/day was observed. Multiple Cox regression analysis revealed significant correlation between net positive fluid removal ≥2000 cc/day and higher patient survival [p = 0.01, hazard ratio (HR) = 13.2], higher first albumin (albumin ≥ 3.5 mg/dL, p = 0.01, HR = 0.02), and lower negative selection (p = 0.0001, HR = 11.8). CONCLUSION: Loss of UV over time and lower net positive fluid removal increase mortality of PD patients.

A Prospective Study on Risk Factors for Acute Kidney Injury and All-Cause Mortality in Hospitalized COVID-19 Patients From Tehran (Iran).

Background: Several reports suggested that acute kidney injury (AKI) is a relatively common occurrence in hospitalized COVID-19 patients, but its prevalence is inconsistently reported across different populations. Moreover, it is unknown whether AKI results from a direct infection of the kidney by SARS-CoV-2 or it is a consequence of the physiologic disturbances and therapies used to treat COVID-19. We aimed to estimate the prevalence of AKI since it varies by geographical settings, time periods, and populations studied and to investigate whether clinical information and laboratory findings collected at hospital admission might influence AKI incidence (and mortality) in a particular point in time during hospitalization for COVID-19. Methods: Herein we conducted a prospective longitudinal study investigating the prevalence of AKI and associated factors in 997 COVID-19 patients admitted to the Baqiyatallah general hospital of Tehran (Iran), collecting both clinical information and several dates (of: birth; hospital admission; AKI onset; ICU admission; hospital discharge; death). In order to examine how the clinical factors influenced AKI incidence and all-cause mortality during hospitalization, survival analysis using the Cox proportional-hazard models was adopted. Two separate multiple Cox regression models were fitted for each outcome (AKI and death). Results: In this group of hospitalized COVID-19 patients, the prevalence of AKI was 28.5% and the mortality rate was 19.3%. AKI incidence was significantly enhanced by diabetes, hyperkalemia, higher levels of WBC count, and blood urea nitrogen (BUN). COVID-19 patients more likely to die over the course of their hospitalization were those presenting a joint association between ICU admission with either severe COVID-19 or even mild/moderate COVID-19, hypokalemia, and higher levels of BUN, WBC, and LDH measured at hospital admission. Diabetes and comorbidities did not increase the mortality risk among these hospitalized COVID-19 patients. Conclusions: Since the majority of patients developed AKI after ICU referral and 40% of them were admitted to ICU within 2 days since hospital admission, these patients may have been already in critical clinical conditions at admission, despite being affected by a mild/moderate form of COVID-19, suggesting the need of early monitoring of these patients for the onset of eventual systemic complications.

Differential expressions of SIRT1, SIRT3, and SIRT4 in peripheral blood mononuclear cells from patients with type 2 diabetic retinopathy.

This study investigated the mRNA and protein levels of SIRT1, SIRT3, and SIRT4 in peripheral blood mononuclear cells (PBMCs) from type 2 diabetes patients with retinopathy (diabetic retinopathy (DR) patients) (n = 86) and those without retinopathy (n = 103). The mRNA expression of SIRT1 and SIRT3 was found to be significantly higher in diabetic patients with retinopathy compared to those without retinopathy. Notably, protein levels of SIRT1, SIRT3, and SIRT4 were higher in patients with DR compared with controls after adjusting for diabetes duration and taking metformin (p = .001 for SIRT1; p = .001 for SIRT3; p = .005 for SIRT4). In the logistic model, there was a significant association between SIRT3 and DR (p = .0001) independent of age and sex and hyperglycaemia markers including FBS, HbA1c, and diabetic duration. These findings suggest an emerging role of sirtuins in the pathogenesis of retinopathy, but further studies are necessary to establish this concept.

Community perception of water quality in a mining-affected area: a case study for the Certej catchment in the Apuseni Mountains in Romania.

Mining-contaminated sites and the affected communities at risk are important issues on the agenda of both researchers and policy makers, particularly in the former communist block countries in Eastern Europe. Integrated analyses and expert based assessments concerning mining affected areas are important in providing solid policy guidelines for environmental and social risk management and mitigation. Based on a survey for 103 households conducted in a former mining site in the Certej Catchment of the Apuseni Mountains, western Romania, this study assesses local communities' perceptions on the quality of water in their living area. Logistic regression was used to examine peoples' perception on the quality of the main river water and of the drinking water based on several predictors relating to social and economic conditions. The results from the perception analysis were then compared with the measurements of heavy metal contamination of the main river and drinking water undertaken in the same study area. The findings indicate that perception and measurement results for the water quality in the Certej Catchment are convergent, suggesting an obvious risk that mining activities pose on the surface water. However, the perception on drinking water quality was little predicted by the regression model and does not seem to be so much related to mining as to other explanatory factors, such as special mineralogy of rock and soils or improper water treatment infrastructure, facts suggested by the measurements of the contaminants. Discussion about the implications of these joint findings for risk mitigation policies completes this article.

Percutaneous biopsy of kidney; comparison between prone position and sitting position.

INTRODUCTION: Percutaneous kidney biopsy has been established as a safe, reliable and minimally invasive method. This study aims to describe the author's experience with biopsy of the kidney and to compare the results in sitting position versus prone in terms of the complication rate. MATERIALS AND METHODS: Patients were divided into two groups: prone and sitting position according to the clinician's and patient's preference. Followed by kidney biopsy, a questionnaire was completed. Then, data and the mean number of glomeruli in each group were compared. RESULTS: Apart from sweat, presumably due to the prone position, no significant differences were found regarding the side effects including dizziness, seizure, nausea, and vomiting between the two groups. The number of glomeruli was not significantly different between two groups. CONCLUSION: In comparison with the prone position, kidney biopsy at sitting position is more comfortable at least for patients who seems couldn't tolerate prone position. We recommend sitting position for kidney biopsy owing to the low side effects rate of this diagnostic technique.

Evaluation the effectiveness of an educational intervention to decrease central line-associated bloodstream infections among hemodialysis patients.

The study aimed to compare the rates of central line-associated bloodstream infection (CLABSI) for all hemodialysis patients with a central catheter across the majority of Shariati hospital wards during a 6-month, 2-phase, before-and-after intervention. The median rate of CLABSI decreased from 18.1% at baseline to 6.5% after implementation of the intervention (64% reduction in CLABSI rate) (P = .002). The data analysis indicated that providing intensive training can positively influence the control of CLABSI in large teaching hospitals.

Esophageal Perforation in a Patient With Kidney Transplantation.

Esophageal perforation is a rupture of the esophageal wall, caused by iatrogenesis in 56% of cases. Perforation of the esophagus remains a challenge, and its incidence has increased as the use of endoscopic procedures has become more frequent. We report a 54-year-old woman with esophageal perforation 8 days after kidney transplantation. She had received a gastrointestinal consultation prior to her transplantation. This report highlights the fact that perforation may occur after any organ transplantation, especially during the initial 2 weeks after transplantation, when mycophenolate mofetil and cyclosporine as well as and high doses of corticosteroid are administered. If there is a delay in passage and a swallowing difficulty, high doses of immunosuppressive drugs are likely to cause ulceration and perforation. Preventive strategies including intravenous steroids for the first 2 to 3 weeks and divided doses of pills should be considered for such patients.

Occult hepatitis C virus infection in Iranian hemodialysis patients.

BACKGROUND: Occult hepatitis C virus (HCV) infection is defined as the presence of HCV-RNA in liver or peripheral blood mononuclear cells (PBMCs) in the absence of detectable hepatitis C antibody (anti-HCV) or HCV-RNA in the serum. Low concentrations of HCV-RNA may be detected in PBMCs of hemodialysis (HD) patients and this could have a great impact on the management of HD patients. OBJECTIVES: The aim of this study was to detect the occult HCV infection in Iranian HD patients. PATIENTS AND METHODS: A total of 70 anti-HCV negative HD patients from three dialysis units in Tehran, Iran were included in this study. In these cases, presence of HCV-RNA in plasma samples was tested by reverse transcriptase-nested polymerase chain reaction (RT-nested PCR). In cases with negative anti-HCV and plasma HCV-RNA, genomic HCV-RNA was checked in PBMC specimens by RT-nested PCR. RESULTS: Seventy anti-HCV negative HD patients were enrolled in the study. 32.85% and 1.43% of cases had elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) respectively. 7.14% of patients had elevated levels of both ALT and AST. HCV-RNA was negative in plasma samples of all anti-HCV negative HD subjects. The genomic HCV-RNA was not detected in any PBMC samples of HD cases with negative anti-HCV and plasma HCV-RNA. CONCLUSIONS: Occult HCV infection was not detected in our HD patients despite of elevated levels of liver enzymes in some participants. Further studies involving larger number of HD patients are required to elucidate the rate of occult HCV infection in HD cases.

Incidence and complications of acute kidney injury following coronary artery bypass graft: a retrospective cohort study.

INTRODUCTION: Acute kidney injury (AKI) is a common complication of coronary artery bypass graft with several serious complications. This study aimed to find the incidence of AKI after coronary artery bypass graft and its complications based on the Acute Kidney Injury Network (AKIN) criteria. MATERIALS AND METHODS: This study was done on 3470 patients who had undergone isolated coronary artery bypass graft. Acute kidney injury's incidence was based on the AKIN criteria (only based on serum creatinine irrespective of urine output). Patients' demographic data, in-hospital complications, and out-hospital mortality were collected from hospital databases and compared between the patients with and without AKI. RESULTS: Based on serum creatinine, the incidence of AKI was 27.7% (958 patients) on the 1st postoperative day. Nine patients (0.3%) needed hemodialysis during their hospital stay, and 31 patients (0.7%) developed persistent kidney failure until the discharge day. The number of patients undergoing hemodialysis was not significantly difference but persistent kidney failure was significantly more frequent in patients with AKI (P < .001). Those with AKI also experienced longer length of stay (P = .04) and longer length of stay in intensive care unit (P < .001), and their mortality rate was higher in hospital (P < .001) and during the 3-year follow-up period (P < .001). CONCLUSIONS: Although AKI is associated with great patients' morbidity and in-hospital and long-term mortality, most of AKI episodes after coronary artery bypass graft are mild with no need for hemodialysis, and they mostly improve spontaneously.

Mapping of human health risks arising from soil nickel and mercury contamination.

Elevated contents of mercury (Hg) and nickel (Ni) in soils and foodstuffs can threaten human health. As contents of these metals in soil, water and food vary from place to place, the associated risks will also be different in various parts of a region and it should be considered for environmental decision making and human health management. The objective of this study was to map the variation of human health risks related to Ni and Hg in soil, water and foodstuffs across an entire region, in province of Hamedan western Iran as an example case. Risks were calculated using the methods proposed by USEPA. The risk maps showed that total non-cancer relative risks of Ni and Hg were much higher than 1 (critical level). Risk of Ni in Razan and Kaboudarahang was higher than other counties. For some areas, relative non-cancer risks associated with exposure to Hg were estimated up to 7 and 11 in children and adults respectively. Consumption of plant foods particularly wheat was found to be the major route of human exposure to Ni and Hg. Soil ingestion was found to be another important route of human exposure to these metals.

Glomerular filtration rate is related to severity of obstructive coronary artery disease in patients undergoing coronary angiography.

PURPOSE: Chronic kidney disease is independently associated with an increased risk of cardiovascular events; however, the relationship between the glomerular filtration rate (GFR) and coronary artery disease (CAD) in patients undergoing coronary angiography has yet to be fully elucidated. METHODS: This retrospective study enrolled a total of 7968 patients who underwent diagnostic coronary artery catheterization [mean age = 54.8 ± 10.6 years, 74.4% males] and did not have any previous history of coronary revascularization, diabetes mellitus, hypertension, end-stage renal disease treated by dialysis or renal transplantation, and were not taking diuretics or drugs acting on renin angiotensin system. The severity of CAD was defined as the number of coronary arteries with a luminal stenosis ≥50% on the angiogram, and the GFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). RESULTS: There were 2133 (26.8%) patients with GFR ≥ 90 ml/min/1.73 m(2), 4574 (57.4%) patients with 60 ≤ GFR < 90 ml/min/1.73 m(2), 1073 (13.5%) with 45 ≤ GFR < 60 ml/min/1.73 m(2) and 181 (2.3%) with 15 < GFR < 45 ml/min/1.73 m(2). After adjustment for traditional cardiovascular risk factors (age, sex, dyslipidemia, low to high-density lipoprotein ratio, smoking status, and family history), the GFR showed a significant association with the severity of CAD and remained a significant predictor of CAD (Odds Ratio raised from 1.1 in patients with 60 ≤ GFR < 90 ml/min/1.73 m(2) to 1.8 in patients with 15 < GFR < 45 ml/min/1.73 m(2)). CONCLUSIONS: A reduced kidney function, even mildly, is significantly associated with CAD severity, independently of other traditional CAD risk factors.

Hemodialysis adequacy and treatment in Iranian patients: a national multicenter study.

INTRODUCTION: Assessment of the hemodialysis adequacy is one of the key factors in evaluating health service system. This would provide a good background for effective future planning by healthcare authorities. In this study, we aimed to evaluate the hemodialysis adequacy in Iran. MATERIALS AND METHODS: One hundred and twenty-seven hemodialysis centers affiliated to 30 medical universities in Iran participated in this cross-sectional multicenter national study. All demographic data as well as hemodialysis prescription data, including blood flow rate, length of the hemodialysis session, hemodialysis membrane type, and composition of the dialysis solution were recorded for each patient. In addition, urea reduction ratio and Kt/V were calculated to determine the hemodialysis adequacy. RESULTS: A total of 4004 patients were included in this study, 2345 men (58.6%) and 1659 women (41.4%). Bicarbonate-based solutions and low-flux membranes were prescribed for 77.0% and 97.6% of the patients, respectively. The mean blood flow rate was 242.9 ± 39.2 mL/min. The mean length of hemodialysis session was 229.2 ± 22.2 minutes. The mean urea reduction ratio and Kt/V were calculated to be 61.0 ± 11.8% and 1.2 ± 0.4, respectively. A Kt/V less than 1.2 and a urea reduction ratio less than 65% were found in 56.7%, and 65.2% of the hemodialysis patients, respectively. CONCLUSIONS: This study showed a substantial inadequate hemodialysis in Iran as compared with the Kidney Disease Outcomes Quality Initiative guidelines. Considering the impact of dialysis adequacy on quality of life and survival rates, as well as healthcare costs, rigorous attempts to achieve the desired goals are necessary.

Predictors of patient survival in continuous ambulatory peritoneal dialysis: 10-year experience in 2 major centers in Tehran.

INTRODUCTION: Many factors have been proposed to be associated with higher mortality in patients on continuous ambulatory peritoneal dialysis (CAPD). However, the relative importance of these factors may differ among patients with different characteristics. We evaluated survival of patients on CAPD and its influencing factors in Iran. MATERIALS AND METHODS: We enrolled 282 patients on CAPD between 1996 and 2006 at 2 major CAPD centers in Tehran. Patient survival was investigated during this period. Demographic characteristics, laboratory data, dialysis adequacy parameters, residual renal function, peritoneal transport characteristics, and nutritional status were assessed as potential predictors of the outcome. RESULTS: The mean duration of follow-up was 18.4 +/- 14.5 months. Sixty patients (21%) died during the studied period. In univariate analysis, age, body mass index, history and duration of hemodialysis before CAPD, diabetes mellitus, blood pressure, patient selection criteria, edema, peritonitis, renal residual function, urine volume, dialysis adequacy, and serum levels of cholesterol, triglyceride, intact parathyroid hormone, calcium, and albumin were predictors of patient survival. Multivariate analysis demonstrated that old age, diabetes mellitus, prior hemodialysis longer than 7 months, low serum albumin, calcium, trigelyceride, and parathyroid hormone levels independently predicted mortality, while the use of angiotensin-converting enzyme inhibitors was associated with a better survival. CONCLUSIONS: This study showed that older patients on CAPD and diabetics are at a higher risk of mortality. On the other hand, nutritional and metabolic factors are other predictors of mortality. Especial concern should be applied to good nutrition and treatment of comorbidities in these patients.

Occult hepatitis B virus infection in hemodialysis patients with isolated hepatitis B core antibody: a multicenter study.

Occult hepatitis B virus (HBV) infection is characterized by presence of HBV infection with undetectable hepatitis B surface antigen (HBsAg). Occult HBV infection harbors potential risk of HBV transmission through hemodialysis (HD). The aim of this study was to assess the occult HBV infection in hemodialysis patients with isolated hepatitis B core antibody (anti-HBc). A total of 289 HD patients from five dialysis units in Tehran, Iran, were included in this study. Hepatitis B surface antigen (HBsAg), Hepatitis B surface antibody (anti-HBs), anti-HBc, Hepatitis C antibody (anti-HCV), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were tested in all subjects. The presence of HBV-DNA was determined quantitatively in plasma samples of HD patients with isolated anti-HBc (HBsAg negative, anti-HBs negative and anti-HBc positive) by real-time PCR using the artus HBV RG PCR kit on the Rotor-Gene 3000 real-time thermal cycler. Of 289 patients enrolled in this study, 18 subjects (6.2%, 95% confidence interval (CI), 3.5%-8.9%) had isolated anti-HBc. HBV-DNA was detectable in 9 of 18 patients (50%, 95% CI, 27%-73%) who had isolated anti-HBc. Plasma HBV-DNA load was less than 50 IU/ml in all of these patients. Our study showed that detection of isolated anti-HBc could reflect unrecognized occult HBV infection in HD patients. The majority of these infections are associated with low viral loads.

N-acetylcysteine does not prevent contrast-induced nephropathy after cardiac catheterization in patients with diabetes mellitus and chronic kidney disease: a randomized clinical trial.

BACKGROUND: Patients with diabetes mellitus (DM) and chronic kidney disease (CKD) constitute to be a high-risk population for the development of contrast-induced nephropathy (CIN), in which the incidence of CIN is estimated to be as high as 50%. We performed this trial to assess the efficacy of N-acetylcysteine (NAC) in the prevention of this complication. METHODS: In a prospective, double-blind, placebo controlled, randomized clinical trial, we studied 90 patients undergoing elective diagnostic coronary angiography with DM and CKD (serum creatinine > or = 1.5 mg/dL for men and > or = 1.4 mg/dL for women). The patients were randomly assigned to receive either oral NAC (600 mg BID, starting 24 h before the procedure) or placebo, in adjunct to hydration. Serum creatinine was measured prior to and 48 h after coronary angiography. The primary end-point was the occurrence of CIN, defined as an increase in serum creatinine > or = 0.5 mg/dL (44.2 micromol/L) or > or = 25% above baseline at 48 h after exposure to contrast medium. RESULTS: Complete data on the outcomes were available on 87 patients, 45 of whom had received NAC. There were no significant differences between the NAC and placebo groups in baseline characteristics, amount of hydration, or type and volume of contrast used, except in gender (male/female, 20/25 and 34/11, respectively; P = 0.005) and the use of statins (62.2% and 37.8%, respectively; P = 0.034). CIN occurred in 5 out of 45 (11.1%) patients in the NAC group and 6 out of 42 (14.3%) patients in the placebo group (P = 0.656). CONCLUSION: There was no detectable benefit for the prophylactic administration of oral NAC over an aggressive hydration protocol in patients with DM and CKD. TRIAL REGISTRATION: NCT00808795.