Sodium bicarbonate plus N-acetylcysteine prophylaxis: a meta-analysis.
OBJECTIVE
We sought to conduct a meta-analysis to compare N-acetylcysteine (NAC) in combination with sodium bicarbonate (NaHCO(3)) for the prevention of contrast-induced acute kidney injury (AKI).


BACKGROUND
Contrast-induced AKI is a serious consequence of cardiac catheterizations and percutaneous coronary interventions (PCI). Despite recent supporting evidence for combination therapy, not enough has been done to prevent the occurrence of contrast-induced AKI prophylactically.


METHODS
Published randomized controlled trial data were collected from OVID/PubMed, Web of Science, and conference abstracts. The outcome of interest was contrast-induced AKI, defined as a >or=25% or >or=0.5 mg/dl increase in serum creatinine from baseline. Secondary outcome was renal failure requiring dialysis.


RESULTS
Ten randomized controlled trials met our criteria. Combination treatment of NAC with intravenous NaHCO(3) reduced contrast-induced AKI by 35% (relative risk: 0.65; 95% confidence interval: 0.40 to 1.05). However, the combination of N-acetylcysteine plus NaHCO(3) did not significantly reduce renal failure requiring dialysis (relative risk: 0.47; 95% confidence interval: 0.16 to 1.41).


CONCLUSIONS
Combination prophylaxis with NAC and NaHCO(3) substantially reduced the occurrence of contrast-induced AKI overall but not dialysis-dependent renal failure. Combination prophylaxis should be incorporated for all high-risk patients (emergent cases or patients with chronic kidney disease) and should be strongly considered for all interventional radio-contrast procedures.
Brown
Jeremiah R
JR
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA. jbrown@Dartmouth.edu
Block
Clay A
CA
Malenka
David J
DJ
O'Connor
Gerald T
GT
Schoolwerth
Anton C
AC
Thompson
Craig A
CA
D000111:Acetylcysteine / Q000008:administration & dosage / Q000627:therapeutic use*; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control; D000284:Administration, Oral; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D016166:Free Radical Scavengers / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D018570:Risk Assessment; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D015415:Biomarkers; D003287:Contrast Media; D016166:Free Radical Scavengers; D017693:Sodium Bicarbonate; D003404:Creatinine; D000111:Acetylcysteine