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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

  • Nephrology - Original Paper
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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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References

  1. Parfrey PS, Griffiths SM, Barrett BJ et al (1989) Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. A prospective controlled study. N Engl J Med 320:143–149

    Article  PubMed  CAS  Google Scholar 

  2. Weisbord SD, Mor MK, Resnick AL et al (2008) Prevention, incidence, and outcomes of contrast-induced acute kidney injury. Arch Intern Med 168:1325–1332

    Article  PubMed  Google Scholar 

  3. Mitchell AM, Jones AE, Tumlin JA, Kline JA (2010) Incidence of contrast-induced nephropathy after contrast-enhanced computed tomography in the outpatient setting. Clin J Am Soc Nephrol 5:4–9

    Article  PubMed  Google Scholar 

  4. Thomsen HS, Morcos SK (2006) Contrast-medium-induced nephropathy: is there a new consensus? A review of published guidelines. Eur Radiol 16:1835–1840

    Article  PubMed  Google Scholar 

  5. Sandstede JJ, Roth A, Machann W, Kaupert C, Hahn D (2007) Evaluation of the nephrotoxicity of iodixanol in patients with predisposing factors to contrast medium induced nephropathy referred for contrast enhanced computed tomography. Eur J Radiol 63:120–123

    Article  PubMed  Google Scholar 

  6. Huber W, Eckel F, Hennig M et al (2006) Prophylaxis of contrast material-induced nephropathy in patients in intensive care: acetylcysteine, theophylline, or both? A randomized study. Radiology 239:793–804

    Article  PubMed  Google Scholar 

  7. Baliga R, Ueda N, Walker PD, Shah SV (1997) Oxidant mechanisms in toxic acute renal failure. Am J Kidney Dis 29:465–477

    Article  PubMed  CAS  Google Scholar 

  8. Kelly AM, Dwamena B, Cronin P, Bernstein SJ, Carlos RC (2008) Meta-analysis:effectiveness of drugs for preventing contrast-induced nephropathy. Ann Intern Med 148:284–294

    Article  PubMed  Google Scholar 

  9. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–e34

    Article  PubMed  Google Scholar 

  10. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  PubMed  CAS  Google Scholar 

  11. Burns KE, Priestap F, Martin C (2010) N-acetylcysteine in critically ill patients undergoing contrast-enhanced computed tomography: a randomized trial. Clin Nephrol 74:323–326

    Article  PubMed  CAS  Google Scholar 

  12. Poletti PA, Saudan P, Platon A et al (2007) I.v. N-acetylcysteine and emergency CT: use of serum creatinine and cystatin C as markers of radiocontrast nephrotoxicity. AJR Am J Roentgenol 189:687–692

    Article  PubMed  Google Scholar 

  13. Sar F, Saler T, Ecebay A, Saglam ZA, Ozturk S, Kazancioglu R (2010) The efficacy of n-acetylcysteine in preventing contrast-induced nephropathy in type 2 diabetic patients without nephropathy. J Nephrol 23:478–482

    PubMed  Google Scholar 

  14. Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W (2000) Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 343:180–184

    Article  PubMed  CAS  Google Scholar 

  15. Hsu TF, Huang MK, Yu SH et al (2012) N-acetylcysteine for the prevention of contrast-induced nephropathy in the emergency department. Intern Med 51:2709–2714

    PubMed  CAS  Google Scholar 

  16. Kitzler TM, Jaberi A, Sendlhofer G et al (2012) Efficacy of vitamin E and N-acetylcysteine in the prevention of contrast induced kidney injury in patients with chronic kidney disease: a double blind, randomized controlled trial. Wien Klin Wochenschr 124:312–319

    Article  PubMed  CAS  Google Scholar 

  17. Perkins BA, Nelson RG, Ostrander BE et al (2005) Detection of renal function decline in patients with diabetes and normal or elevated GFR by serial measurements of serum cystatin C concentration: results of a 4-year follow-up study. J Am Soc Nephrol 16:1404–1412

    Article  PubMed  Google Scholar 

  18. Trivedi H, Daram S, Szabo A, Bartorelli AL, Marenzi G (2009) High-dose N-acetylcysteine for the prevention of contrast-induced nephropathy. Am J Med 122(874):e9–e15

    PubMed  Google Scholar 

  19. Mueller C, Buerkle G, Buettner HJ et al (2002) Prevention of contrast media-associated nephropathy: randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty. Arch Intern Med 162:329–336

    Article  PubMed  CAS  Google Scholar 

  20. Thiele H, Hildebrand L, Schirdewahn C et al (2010) Impact of high-dose N-acetylcysteine versus placebo on contrast-induced nephropathy and myocardial reperfusion injury in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. The LIPSIA-N-ACC (Prospective, Single-Blind, Placebo-Controlled, Randomized Leipzig Immediate Percutaneous Coronary Intervention Acute Myocardial Infarction N-ACC) trial. J Am Coll Cardiol 55:2201–2209

    Article  PubMed  CAS  Google Scholar 

  21. Brown JR, Block CA, Malenka DJ, O’Connor GT, Schoolwerth AC, Thompson CA (2009) Sodium bicarbonate plus N-acetylcysteine prophylaxis: a meta-analysis. JACC Cardiovasc Interv 2:1116–1124

    Article  PubMed  Google Scholar 

  22. Herts BR, Schneider E, Poggio ED, Obuchowski NA, Baker ME (2008) Identifying outpatients with renal insufficiency before contrast-enhanced CT by using estimated glomerular filtration rates versus serum creatinine levels. Radiology 248:106–113

    Article  PubMed  Google Scholar 

  23. Rehman T, Fought J, Solomon R (2008) N-acetylcysteine effect on serum creatinine and cystatin C levels in CKD patients. Clin J Am Soc Nephrol 3:1610–1614

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

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Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, Taipei, Taiwan

    Mei-Yi Wu, Yung-Ho Hsu & Yuh-Feng Lin

  2. Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan

    Hui-Fen Hsiang, Yun-Wen Li & Chao-Ying Hsiang

  3. Department of Emergency Medicine, Taipei Medical University, Shuang Ho Hospital, Taipei, Taiwan

    Chung-Shun Wong

  4. Department of Radiology, Taipei Medical University, Wan Fang Hospital, Taipei, Taiwan

    Min-Szu Yao

  5. School of Public Health, Taipei Medical University, Taipei, Taiwan

    Chyi-Huey Bai

  6. Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, No. 252 Wu-Hsing Street, Taipei, 11031, Taiwan

    Ka-Wai Tam

  7. Center for Evidence-Based Medicine, Taipei Medical University, Taipei, Taiwan

    Ka-Wai Tam

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  1. Mei-Yi Wu
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  2. Hui-Fen Hsiang
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  8. Yung-Ho Hsu
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Corresponding author

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

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