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N-acetylcysteine prophylaxis significantly reduces the risk of radiocontrast-induced nephropathy: comprehensive meta-analysis.

Abstract

The objectives of this study was to assess the overall effect of N-acetylcysteine (NAC) in preventing radiocontrast-induced nephropathy (RCIN) using all available data in the literature. RCIN is associated with increased morbidity and mortality. Existing randomized trials of NAC are small and show inconsistent results. Prior meta-analyses do not include data from the most current studies. We used standard search protocols to identify all published articles and abstracts of prospective trials using NAC with fluid hydration compared to hydration alone in patients with chronic renal insufficiency undergoing contrast procedures. A rise in serum creatinine by 0.5 mg/dl or 25% above baseline at 48-72 hr after contrast exposure was used as the primary outcome. We identified 14 trials of NAC with 1,584 patients published as full-text articles. Using a random-effects model, the use of oral NAC resulted in a significant reduction in the risk for developing RCIN (RR = 0.57; 95% CI = 0.37-0.84; P = 0.01). This finding did not significantly change in a fixed-effect model (RR = 0.55; 95% CI = 0.42-0.73) or when the data were reanalyzed using only randomized trials in all forms (i.e., articles and abstracts; RR = 0.67; 95% CI = 0.47-0.95). We identified only one important difference between the positive and the negative studies: the cumulative exposure to contrast media (174 vs. 152 ml). Metaregression did not show a significant relationship between contrast volume and the RR of developing RCIN (P > 0.10). In the trials showing benefit for NAC, the treated patients' postprocedure creatinine unexpectedly decreased by 0.21 mg/dl (95% CI = 0.33-0.08). Prophylaxis with NAC significantly reduces the risk for RCIN. The reasons for improvement in serum creatinine in patients treated with NAC are unclear, but may include improved renal blood flow due to NAC and/or vigorous hydration.

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  • Authors+Show Affiliations

    ,

    Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NW 03756, USA. michael.h.duong@hitchcock.org

    ,

    Source

    MeSH

    Acetylcysteine
    Acute Kidney Injury
    Contrast Media
    Coronary Angiography
    Female
    Follow-Up Studies
    Humans
    Kidney Function Tests
    Male
    Primary Prevention
    Radiopharmaceuticals
    Randomized Controlled Trials as Topic
    Risk Assessment
    Severity of Illness Index
    Tomography, X-Ray Computed

    Pub Type(s)

    Comparative Study
    Journal Article
    Meta-Analysis
    Review

    Language

    eng

    PubMed ID

    15789388

    Citation

    Duong, Michael H., et al. "N-acetylcysteine Prophylaxis Significantly Reduces the Risk of Radiocontrast-induced Nephropathy: Comprehensive Meta-analysis." Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, vol. 64, no. 4, 2005, pp. 471-9.
    Duong MH, MacKenzie TA, Malenka DJ. N-acetylcysteine prophylaxis significantly reduces the risk of radiocontrast-induced nephropathy: comprehensive meta-analysis. Catheter Cardiovasc Interv. 2005;64(4):471-9.
    Duong, M. H., MacKenzie, T. A., & Malenka, D. J. (2005). N-acetylcysteine prophylaxis significantly reduces the risk of radiocontrast-induced nephropathy: comprehensive meta-analysis. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, 64(4), pp. 471-9.
    Duong MH, MacKenzie TA, Malenka DJ. N-acetylcysteine Prophylaxis Significantly Reduces the Risk of Radiocontrast-induced Nephropathy: Comprehensive Meta-analysis. Catheter Cardiovasc Interv. 2005;64(4):471-9. PubMed PMID: 15789388.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - N-acetylcysteine prophylaxis significantly reduces the risk of radiocontrast-induced nephropathy: comprehensive meta-analysis. AU - Duong,Michael H, AU - MacKenzie,Todd A, AU - Malenka,David J, PY - 2005/3/25/pubmed PY - 2005/8/5/medline PY - 2005/3/25/entrez SP - 471 EP - 9 JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions JO - Catheter Cardiovasc Interv VL - 64 IS - 4 N2 - The objectives of this study was to assess the overall effect of N-acetylcysteine (NAC) in preventing radiocontrast-induced nephropathy (RCIN) using all available data in the literature. RCIN is associated with increased morbidity and mortality. Existing randomized trials of NAC are small and show inconsistent results. Prior meta-analyses do not include data from the most current studies. We used standard search protocols to identify all published articles and abstracts of prospective trials using NAC with fluid hydration compared to hydration alone in patients with chronic renal insufficiency undergoing contrast procedures. A rise in serum creatinine by 0.5 mg/dl or 25% above baseline at 48-72 hr after contrast exposure was used as the primary outcome. We identified 14 trials of NAC with 1,584 patients published as full-text articles. Using a random-effects model, the use of oral NAC resulted in a significant reduction in the risk for developing RCIN (RR = 0.57; 95% CI = 0.37-0.84; P = 0.01). This finding did not significantly change in a fixed-effect model (RR = 0.55; 95% CI = 0.42-0.73) or when the data were reanalyzed using only randomized trials in all forms (i.e., articles and abstracts; RR = 0.67; 95% CI = 0.47-0.95). We identified only one important difference between the positive and the negative studies: the cumulative exposure to contrast media (174 vs. 152 ml). Metaregression did not show a significant relationship between contrast volume and the RR of developing RCIN (P > 0.10). In the trials showing benefit for NAC, the treated patients' postprocedure creatinine unexpectedly decreased by 0.21 mg/dl (95% CI = 0.33-0.08). Prophylaxis with NAC significantly reduces the risk for RCIN. The reasons for improvement in serum creatinine in patients treated with NAC are unclear, but may include improved renal blood flow due to NAC and/or vigorous hydration. SN - 1522-1946 UR - https://www.unboundmedicine.com/medline/citation/15789388/full_citation L2 - https://doi.org/10.1002/ccd.20342 DB - PRIME DP - Unbound Medicine ER -