title: Intravenous N-acetylcysteine for prevention of contrast-induced nephropathy: a meta-analysis of randomized, controlled trials.
abstract: BACKGROUND
  Contrast-induced nephropathy (CIN) is one of the common causes of acute renal insufficiency after contrast procedures. Whether intravenous N-acetylcysteine (NAC) is beneficial for the prevention of contrast-induced nephropathy is uncertain. In this meta-analysis of randomized controlled trials, we aimed to assess the efficacy of intravenous NAC for preventing CIN after administration of intravenous contrast media.
  
  
  METHODS
  Relevant studies published up to September 2012 that investigated the efficacy of intravenous N-acetylcysteine for preventing CIN were collected from MEDLINE, OVID, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and the conference proceedings from major cardiology and nephrology meetings. The primary outcome was CIN. Secondary outcomes included renal failure requiring dialysis, mortality, and length of hospitalization. Data were combined using random-effects models with the performance of standard tests to assess for heterogeneity and publication bias. Meta-regression analyses were also performed.
  
  
  RESULTS
  Ten trials involving 1916 patients met our inclusion criteria. Trials varied in patient demographic characteristics, inclusion criteria, dosing regimens, and trial quality. The summary risk ratio for contrast-induced nephropathy was 0.68 (95% CI, 0.46 to 1.02), a nonsignificant trend towards benefit in patients treated with intravenous NAC. There was evidence of significant heterogeneity in NAC effect across studies (Q = 17.42, P = 0.04; I(2) = 48%). Meta-regression revealed no significant relation between the relative risk of CIN and identified differences in participant or study characteristics.
  
  
  CONCLUSIONS
  This meta-analysis showed that research on intravenous N-acetylcysteine and the incidence of CIN is too inconsistent at present to warrant a conclusion on efficacy. A large, well designed trial that incorporates the evaluation of clinically relevant outcomes in participants with different underlying risks of CIN is required to more adequately assess the role for intravenous NAC in CIN prevention.
authors: Cardiovascular Department, Zhujiang Hospital, Southern Medical University, Guangdong Province, China.
authors: Zikai
authors: Z
authors: Sun
authors: Qiang
authors: Q
authors: Fu
authors: Longxing
authors: L
authors: Cao
authors: Wen
authors: W
authors: Jin
authors: Lingling
authors: L
authors: Cheng
authors: Zhiliang
authors: Z
authors: Li
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology*; D061605:Administration, Intravenous; D003287:Contrast Media / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control* / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D000111:Acetylcysteine
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