title: Measures used to treat contrast-induced nephropathy: overview of reviews.
abstract: OBJECTIVE
  Despite many interventions that have been tried, controversy remains regarding the efficacy of interventions for contrast-induced nephropathy (CIN), so we aimed to evaluate the best evidence from recent meta-analyses.
  
  
  METHODS
  We searched MEDLINE, EMBASE and the Cochrane library for interventions which have been used for CIN. We included only the most recent meta-analysis of each intervention. We extracted data on the methodology, quality and results of each meta-analysis. We performed narrative synthesis and adjusted indirect comparison of interventions that were shown to be statistically significant compared with a placebo.
  
  
  RESULTS
  We included 7 systematic reviews and meta-analyses involving 9 different interventions for CIN, with a total of 15 976 participants. A significantly decreased risk of CIN was reported in meta-analysis of the following interventions: N-acetylcysteine [odds ratio (OR) 0.65, 95% confidence interval (CI) 0.48-0.88, I(2)=64%], theophylline [relative risk (RR) 0.48, 95% CI 0.26-0.89, I(2)=44%], statins (RR 0.51, 95% CI 0.34-0.77, I(2)=0%) and sodium bicarbonate (RR 0.62, 95% CI 0.45-0.86, I(2)=49%). Furosemide was shown to increase the risk of CIN (RR 3.27, 95% CI 1.48-7.26, I(2)=0%). Other interventions such as renal replacement therapy, angiotensin-converting enzyme inhibitors, dopamine and fenoldapam failed to show any significant difference from the control group.
  
  
  CONCLUSIONS
  Although there is some evidence to suggest that N-acetylcysteine, theophylline, sodium bicarbonate and statins may reduce incidence of CIN, limitations in the study quality and heterogeneity preclude any firm recommendations.
  
  
  CONCLUSIONS
  N-acetylcysteine, theophylline, sodium bicarbonate and statins show some promise as potentially efficacious agents for preventing CIN, but more high-quality studies are needed before they can be recommended for use in routine practice.
authors.affiliation: Norfolk and Norwich University Hospital, Norwich, UK. shingkwok@doctors.org.uk
authors.forename: C S
authors.initials: CS
authors.lastname: Kwok
authors.forename: C L
authors.initials: CL
authors.lastname: Pang
authors.forename: J K
authors.initials: JK
authors.lastname: Yeong
authors.forename: Y K
authors.initials: YK
authors.lastname: Loke
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007674:Kidney Diseases / Q000188:drug therapy* / Q000453:epidemiology*; D015995:Prevalence; D018570:Risk Assessment; D017693:Sodium Bicarbonate / Q000627:therapeutic use*; D013806:Theophylline / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017693:Sodium Bicarbonate; D013806:Theophylline; D000111:Acetylcysteine