Abstract
BackgroundContrast-induced nephropathy (CIN) is one of the common causes of acute renal insufficiency after contrast procedures. Whether intravenous N-acetylcysteine (NAC) is beneficial for the prevention of contrast-induced nephropathy is uncertain. In this meta-analysis of randomized controlled trials, we aimed to assess the efficacy of intravenous NAC for preventing CIN after administration of intravenous contrast media.Study DesignRelevant studies published up to September 2012 that investigated the efficacy of intravenous N-acetylcysteine for preventing CIN were collected from MEDLINE, OVID, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and the conference proceedings from major cardiology and nephrology meetings. The primary outcome was CIN. Secondary outcomes included renal failure requiring dialysis, mortality, and length of hospitalization. Data were combined using random-effects models with the performance of standard tests to assess for heterogeneity and publication bias. Meta-regression analyses were also performed.ResultsTen trials involving 1916 patients met our inclusion criteria. Trials varied in patient demographic characteristics, inclusion criteria, dosing regimens, and trial quality. The summary risk ratio for contrast-induced nephropathy was 0.68 (95% CI, 0.46 to 1.02), a nonsignificant trend towards benefit in patients treated with intravenous NAC. There was evidence of significant heterogeneity in NAC effect across studies (Q = 17.42, P = 0.04; I2 = 48%). Meta-regression revealed no significant relation between the relative risk of CIN and identified differences in participant or study characteristics.ConclusionThis meta-analysis showed that research on intravenous N-acetylcysteine and the incidence of CIN is too inconsistent at present to warrant a conclusion on efficacy. A large, well designed trial that incorporates the evaluation of clinically relevant outcomes in participants with different underlying risks of CIN is required to more adequately assess the role for intravenous NAC in CIN prevention.
Highlights
The increasing use of contrast media (CM) for a multitude of radiological procedures, during coronary angiography, has raised concerns about the increasing incidence of a potential complication known as contrast-induced nephropathy (CIN) [1]
The summary risk ratio for contrast-induced nephropathy was 0.68, a nonsignificant trend towards benefit in patients treated with intravenous NAC
This meta-analysis showed that research on intravenous N-acetylcysteine and the incidence of Contrast-induced nephropathy (CIN) is too inconsistent at present to warrant a conclusion on efficacy
Summary
The increasing use of contrast media (CM) for a multitude of radiological procedures, during coronary angiography, has raised concerns about the increasing incidence of a potential complication known as contrast-induced nephropathy (CIN) [1]. Results of the initial trial [9] of oral NAC for the prevention of CIN were impressive, but subsequent studies and meta-analyses performed with the data gathered by these studies have shown that the efficacy of orally-administered NAC for CIN prevention has remained unresolved to date [10]. Contrast-induced nephropathy (CIN) is one of the common causes of acute renal insufficiency after contrast procedures. Whether intravenous N-acetylcysteine (NAC) is beneficial for the prevention of contrast-induced nephropathy is uncertain. In this meta-analysis of randomized controlled trials, we aimed to assess the efficacy of intravenous NAC for preventing CIN after administration of intravenous contrast media
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