Is acetylcysteine effective in preventing contrast-related nephropathy? A meta-analysis.
OBJECTIVE
Clinical trials evaluating acetylcysteine for the prevention of contrast-related nephropathy have reported mixed results. Although previous meta-analyses have concluded that acetylcysteine is beneficial, the recent availability of additional trials calls for reassessment of current evidence.


METHODS
We performed a computerized search to identify relevant published and unpublished randomized clinical trials that evaluated acetylcysteine for the prevention of contrast-related nephropathy. Abstracted data from each trial included assessments of clinical outcomes, trial quality, and additional characteristics. The primary outcome of interest was the incidence of nephropathy after contrast administration. Data were combined using random-effects models with the performance of standard tests to assess for heterogeneity and publication bias. Subgroup analyses were also performed.


RESULTS
Twenty trials involving 2195 patients met our inclusion criteria. Trials varied in patient demographic characteristics, inclusion criteria, dosing regimens, and trial quality. The summary risk ratio for contrast-related nephropathy was 0.73 (95% confidence interval: 0.52 to 1.0; P = 0.08), a nonsignificant trend towards benefit in patients treated with acetylcysteine. This effect varied, however, across the 20 trials (test of heterogeneity, P = 0.04). Although higher-quality trials demonstrated a stronger benefit for acetylcysteine in general, few reported important elements of study design, such as concealment of allocation, placebo-controls, or double-blinding. Heterogeneity was unexplained by subgroup analyses.


CONCLUSIONS
Acetylcysteine may reduce the incidence of contrast-related nephropathy, but this finding is reported inconsistently across currently available trials. High-quality, large clinical trials are needed before acetylcysteine use in this indication can be recommended universally.
Nallamothu
Brahmajee K
BK
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan 48109-0311, USA. bnallamo@umich.edu
Shojania
Kaveh G
KG
Saint
Sanjay
S
Hofer
Timothy P
TP
Humes
H David
HD
Moscucci
Mauro
M
Bates
Eric R
ER
D000111:Acetylcysteine / Q000627:therapeutic use*; D003287:Contrast Media / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D011859:Radiography; D016032:Randomized Controlled Trials as Topic
D003287:Contrast Media; D000111:Acetylcysteine