Acute Coronary Syndrome- NAC

• ACT (2011): Acetylcysteine with IV contrast
  • Acetylcysteine does not prevent contrast-induced acute kidney injury in patients undergoing angiography.

Acute Kidney Injury

• ACT (2011): Acetylcysteine with IV contrast
• AKIKI (2016): Early vs. late RRT in severe AKI in ICU
  • Among ICU patients with AKI, there is no mortality difference between early or delayed RRT.
• ATN (2008): RRT intensity in ATN
  • In critically ill patients with acute tubular necrosis, more intensive renal replacement therapy does not improve all-cause mortality at 60 days compared to conventional less-intensive therapy. In the ATN study, intensive RRT did not improve renal function or nonrenal organ dysfunction, although it was associated with more frequent hypotensive episodes
• IDEAL-ICU (2018): Early vs. delayed RRT in septic shock
  • Among ICU with septic shock and AKI without urgent need for dialysis, there was no difference in 90-day all cause mortality when comparing early-initiation vs. delayed-initiation RRT strategies. Overall use of RRT was lower in the delayed-initiation strategy group.
• SALT-ED (2018): Balanced crystalloids vs. NS in non-critical ED patients
  • Among non-critically ill ED patients, initial fluid resuscitation with balanced crystalloids (Lactated Ringer's or Plasma-Lyte) does not reduce duration of hospitalization when compared to the isotonic crystalloid, normal saline. However, balanced crystalloid use is associated with a reduction in major kidney-related events