title: N-acetylcysteine for the prevention of contrast-induced nephropathy in patients with pre-existing renal insufficiency or diabetes: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To identify benefit of N-acetylcysteine (NAC) on patients with pre-existing renal insufficiency or diabetes.
  
  
  BACKGROUND
  NAC administration is a common method for prevention of contrast-induced nephropathy (CIN). Nevertheless, its benefit on patients with pre-existing renal insufficiency or diabetes remains uncertain and controversial.
  
  
  METHODS
  Randomized controlled trials (RCTs) to evaluate the efficacy of NAC for the prevention of CIN in patients with pre-existing renal insufficiency or diabetes were searched from the databases of MEDLINE, EMBASE, and Cochrane library. Pooled odds ratio (OR) with 95% confidence interval (95% CI) were calculated using fixed-effects model by the Mantel-Haenszel test.
  
  
  RESULTS
  Twenty RCTs involving 3466 subjects (1756 assigned to NAC and 1710 assigned to the control) were included in the pre-existing renal dysfunction group. Pooled analysis suggested a significant reduction in CIN among this group (OR, 0.76; 95% CI, 0.61-0.93; p = 0.008). However, the nine trials comparing NAC versus control among patients with diabetes (NAC, 367 subjects; control, 358 subjects) showed no benefit of NAC for prevention of CIN (OR = 0.87; 95% CI, 0.58-1.30; p = 0.50). No significant heterogeneity was detected (p = 0.07; I2 = 34% for the group of pre-existing renal dysfunction; p = 0.40; I2 = 5% for the group of diabetes).
  
  
  CONCLUSIONS
  Our results suggest that NAC decreases the incidence of contrast-induced nephropathy among patients with pre-existing renal insufficiency. The benefit was not existed in patients with diabetes.
authors.affiliation: a Department of Nephrology and Rheumatology , Shanghai Tenth People's Hospital, Tongji University School of Medicine , Shanghai , PR China and.
authors.forename: Xin
authors.initials: X
authors.lastname: Kang
authors.affiliation: a Department of Nephrology and Rheumatology , Shanghai Tenth People's Hospital, Tongji University School of Medicine , Shanghai , PR China and.
authors.forename: Da-Yong
authors.initials: DY
authors.lastname: Hu
authors.affiliation: a Department of Nephrology and Rheumatology , Shanghai Tenth People's Hospital, Tongji University School of Medicine , Shanghai , PR China and.
authors.forename: Chang-Bin
authors.initials: CB
authors.lastname: Li
authors.affiliation: b Department of Medical Statistics , College of Medicine, Tongji University , Shanghai , PR China.
authors.forename: Zi-Sheng
authors.initials: ZS
authors.lastname: Ai
authors.affiliation: a Department of Nephrology and Rheumatology , Shanghai Tenth People's Hospital, Tongji University School of Medicine , Shanghai , PR China and.
authors.forename: Ai
authors.initials: A
authors.lastname: Peng
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D003287:Contrast Media / Q000009:adverse effects*; D003928:Diabetic Nephropathies / Q000150:complications; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000150:complications
chemical_list: D003287:Contrast Media; D000111:Acetylcysteine
keywords: Contrast-induced nephropathy; N-acetylcysteine; diabetes; meta-analysis; renal insufficiency