title: Effectiveness of Prevention Strategies for Contrast-Induced Nephropathy: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  N-acetylcysteine, sodium bicarbonate, statins, and ascorbic acid have been studied for reducing contrast-induced nephropathy (CIN).
  
  
  OBJECTIVE
  To evaluate the comparative effectiveness of interventions to reduce CIN in adults receiving contrast media.
  
  
  METHODS
  MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov, and Scopus databases through June 2015. Risk of bias and overall strength of evidence (SOE) of studies were assessed.
  
  
  METHODS
  Randomized, controlled trials of N-acetylcysteine, sodium bicarbonate, statins, or ascorbic acid that used intravenous (IV) or intra-arterial contrast media and defined CIN with enough data for meta-analysis.
  
  
  METHODS
  Two reviewers independently extracted data and assessed study quality.
  
  
  RESULTS
  Low-dose N-acetylcysteine plus IV saline compared with IV saline (risk ratio [RR], 0.75 [95% CI, 0.63 to 0.89]; low SOE), N-acetylcysteine plus IV saline compared with IV saline in patients receiving low-osmolar contrast media (RR, 0.69 [CI, 0.58 to 0.84]; moderate SOE), and statins plus N-acetylcysteine plus IV saline versus N-acetylcysteine plus IV saline (RR, 0.52 [CI, 0.29 to 0.93]; low SOE) had clinically important and statistically significant benefits. The following 3 comparisons suggested a clinically important difference that was not statistically significant: sodium bicarbonate versus IV saline in patients receiving low-osmolar contrast media (RR, 0.65 [CI, 0.33 to 1.25]; low SOE), statins plus IV saline versus IV saline (RR, 0.68 [CI, 0.39 to 1.20]; low SOE), and ascorbic acid versus IV saline (RR, 0.72 [CI, 0.48 to 1.01]; low SOE). Strength of evidence was generally insufficient for comparisons of the need for renal replacement, cardiac events, and mortality.
  
  
  CONCLUSIONS
  Too few studies were done in patients receiving IV contrast media.
  
  
  CONCLUSIONS
  The greatest reduction in CIN was seen with N-acetylcysteine plus IV saline in patients receiving LOCM and with statins plus N-acetylcysteine plus IV saline.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.forename: Rathan M
authors.initials: RM
authors.lastname: Subramaniam
authors.forename: Catalina
authors.initials: C
authors.lastname: Suarez-Cuervo
authors.forename: Renee F
authors.initials: RF
authors.lastname: Wilson
authors.forename: Sharon
authors.initials: S
authors.lastname: Turban
authors.forename: Allen
authors.initials: A
authors.lastname: Zhang
authors.forename: Cheryl
authors.initials: C
authors.lastname: Sherrod
authors.forename: Jonathan
authors.initials: J
authors.lastname: Aboagye
authors.forename: John
authors.initials: J
authors.lastname: Eng
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Choi
authors.forename: Susan
authors.initials: S
authors.lastname: Hutfless
authors.forename: Eric B
authors.initials: EB
authors.lastname: Bass
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D001205:Ascorbic Acid / Q000627:therapeutic use; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D016166:Free Radical Scavengers / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D016017:Odds Ratio; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D012965:Sodium Chloride / Q000627:therapeutic use; D014481:United States
chemical_list: D000975:Antioxidants; D003287:Contrast Media; D016166:Free Radical Scavengers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D012965:Sodium Chloride; D017693:Sodium Bicarbonate; D001205:Ascorbic Acid; D000111:Acetylcysteine