High-dose N-acetylcysteine for the prevention of contrast-induced nephropathy. Am J Med 2009 Sep;122(9):874.e9-15
Date
08/25/2009Pubmed ID
19699385DOI
10.1016/j.amjmed.2009.01.035Scopus ID
2-s2.0-68749089747 (requires institutional sign-in at Scopus site) 84 CitationsAbstract
BACKGROUND: Whether N-acetylcysteine is beneficial for the prevention of contrast-induced nephropathy is uncertain.
METHODS: We conducted a meta-analysis to evaluate the efficacy of high-dose N-acetylcysteine for the prevention of contrast-induced nephropathy. Our prespecified inclusion criteria were as follows: adult subjects; English language literature; administration of high-dose N-acetylcysteine a priori defined as a daily dose greater than 1200 mg or a single periprocedural dose (within 4 hours of contrast exposure) greater than 600 mg; prospective trials of individuals randomized to N-acetylcysteine, administered orally or intravenously, versus a control group; and trials that included the end point of the incidence of contrast-induced nephropathy. Trials that compared N-acetylcysteine with another active treatment were excluded.
RESULTS: Sixteen comparisons of patients randomized to high-dose N-acetylcysteine versus controls met our prespecified inclusion criteria with a total sample size of 1677 subjects (842 assigned to high-dose N-acetylcysteine and 835 assigned to the control arm). The average population age was 68 years, 38.7% were diabetic, and the majority was male (67.8% of reported instances). The weighted mean baseline creatinine of the overall population was 1.58 mg/dL. No significant heterogeneity was detected (P = .09; I(2) = 34%). The overall effect size assuming a common odds ratio revealed an odds ratio of 0.46 (95% confidence interval [CI], 0.33-0.63) for the occurrence of contrast-induced nephropathy with the use of high-dose N-acetylcysteine. The results of the more conservative random effects approach were similar (odds ratio = 0.52; 95% CI, 0.34-0.78). There was no evidence of publication bias (P = .34).
CONCLUSION: Our results suggest that high-dose N-acetylcysteine decreases the incidence of contrast-induced nephropathy.
Author List
Trivedi H, Daram S, Szabo A, Bartorelli AL, Marenzi GAuthor
Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AcetylcysteineAged
Contrast Media
Female
Humans
Kidney Diseases
Male