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To the Editor: Dr Kay and colleagues¹ found that in patients with moderate renal insufficiency undergoing coronary angiography, prophylactic use of acetylcysteine with hydration resulted in an 8% absolute risk reduction in the incidence of contrast-induced nephropathy. Despite promising results from additional similar trials with acetylcysteine,^2-3 we are concerned about how the primary end point was defined in this study.

Like other authors,^4-5 Kay et al defined contrast-induced nephropathy as a 25% increase in serum creatinine level, a definition that has traditionally been used as a surrogate end point for reduction in kidney function. It is unclear, however, whether this reflects other clinically important end points such as need for dialysis, length of hospitalization, or mortality.⁶ The study by Kay et al was not designed to detect these as primary outcomes, despite the finding of a half-day reduction in length of hospitalization and that no patient required dialysis. Therefore, we . . . [Full Text of this Article]

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