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June 4, 2003

Outcomes of Medical vs Invasive Therapy for Elderly Patients With Angina

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(21):2794-2796. doi:10.1001/jama.289.21.2794-a

In Reply: In response to Dr Shen, patients with contrast-induced nephropathy typically experience an acute increase in serum creatinine level after the contrast exposure, and this generally returns to baseline by 7 to 10 days.1 It is possible that volume expansion due to intravenous saline might explain the nonsignificant change in the mean serum creatinine level in the control group. Although we did not measure renal function beyond 7 days, the short half-life of acetylcysteine and its short period of administration are not consistent with the delayed development of nephropathy. Studies on the prophylactic use of acetylcysteine have yielded conflicting results.2,3 This is probably because the incidence of contrast-induced nephropathy is difficult to estimate and is highly dependent on the definition of acute renal failure, as well as on the patient population studied.