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The effectiveness of N-acetylcysteine in preventing contrast-induced nephropathy in patients undergoing contrast-enhanced computed tomography: a meta-analysis of randomized controlled trials

Abstract

Background

N-Acetylcysteine (NAC) is reported to have potential for preventing of contrast-induced nephropathy (CIN) in patients undergoing coronary angiography. However, the effectiveness of NAC in preventing CIN in patients undergoing contrast-enhanced computed tomography (CT) is still controversial. We conducted a meta-analysis of relevant randomized controlled trials (RCTs) to further examine this issue.

Methods

RCTs were identified by computerized searching in PubMed, EMBASE, SCOPUS, and Cochrane databases. Two reviewers independently assessed the methodological quality of each study. A meta-analysis was performed to evaluate the effectiveness of NAC in preventing CIN in patients undergoing CT. The primary outcome was the incidence of contrast-induced nephropathy, and the requirement for dialysis. The secondary outcome was the change of serum creatinine.

Results

Six randomized controlled trials were identified with a total of 496 patients meeting the criteria for this study. Prophylactic administration of NAC in patients with serum creatinine above 1.2 mg/dL undergoing contrast-enhanced CT, along with hydration, reduced the risk of CIN (relative risk 0.20; 95 % confidence interval: 0.07–0.57). Requirement for dialysis was not significantly different between the NAC group and the control group.

Conclusions

This review provides evidence of the efficacy of NAC in preventing the incidence of CIN and recommends that NAC be more widely used in high-risk patients undergoing contrast-enhanced CT. On the basis of the evidence reviewed, further research involving large RCTs may be warranted.

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Correspondence to Ka-Wai Tam.

Appendix: Search methods for identification of studies

Appendix: Search methods for identification of studies

Relevant trials will be obtained from the following sources without language restriction:-

  • For the MEDLINE and EMBASE search, we used the following combination of keywords:

    [Renal failure or kidney failure to include all subheadings] and [contrast media or iopamidol or iodine or ioxaglic acid or iodine compounds or iohexol or urography or tomography or X ray computed] and [clinical trial or randomized controlled trial] and [N-Acetylcysteine or acetylcysteine].

  • For the PubMed, Cochrane Library Database, and Scopus searches, we used the search words:

    Acetylcysteine, radio induced or contrast induced, renal insufficiency or renal failure or kidney injury or nephropathy, randomized controlled trial, and computed tomography.

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Wu, MY., Hsiang, HF., Wong, CS. et al. The effectiveness of N-acetylcysteine in preventing contrast-induced nephropathy in patients undergoing contrast-enhanced computed tomography: a meta-analysis of randomized controlled trials. Int Urol Nephrol 45, 1309–1318 (2013). https://doi.org/10.1007/s11255-012-0363-1

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  • DOI: https://doi.org/10.1007/s11255-012-0363-1

Keywords

  • N-Acetylcysteine
  • Contrast-induced nephropathy
  • Computed tomography
  • Meta-analysis