Effectiveness of N-Acetylcysteine for the Prevention of Contrast-Induced Nephropathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
BACKGROUND
Conflicting results have been obtained in trials that have evaluated the prophylactic efficacy of N-acetylcysteine (NAC) pretreatment in the prevention of contrast-induced nephropathy (CIN). In this meta-analysis of randomized controlled trials, we aimed to assess the effectiveness of NAC treatment for the prevention of CIN.


RESULTS
PubMed, EMBASE, and the Cochrane Library were electronically searched from inception to January 2016 for all relevant studies. The weighted relative risk (RR) and corresponding 95% CI for incident CIN were estimated using random effects models. Standard methods for assessing statistical heterogeneity and publication bias were used. The study included 11 480 participants and 1653 cases of CIN. The incidence of CIN was 12.8% in the NAC group versus 16.0% in the control group (RR: 0.76, 95% CI: 0.66-0.88, P=0.0002). In the patients undergoing coronary angiography, the incidence of CIN in the NAC group versus the control group was 13.7% versus 17.2% (RR: 0.74, 95% CI: 0.63-0.87, P=0.0002); in those undergoing peripheral angiography, the incidence was 6.4% versus 5.8% (RR: 1.00, 95% CI: 0.42-2.40, P=1.00); in those undergoing computed tomography, the incidence was 7.7% versus 14.8% (RR: 0.51, 95% CI: 0.29-0.89, P=0.02).


CONCLUSIONS
Our meta-analysis showed an inverse and significant association between NAC supplementation and risk of CIN in patients undergoing coronary angiography and computed tomography, while a protective role for NAC in patients undergoing peripheral angiography was not obvious.
Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Renfan
R
Xu
Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Anyu
A
Tao
Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Yang
Y
Bai
Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Youbin
Y
Deng
Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China chengz2003@163.com.
Guangzhi
G
Chen
N‐acetylcysteine; contrast‐induced nephropathy; coronary angiography; meta‐analysis
Lancet. 1998 Aug 22;352(9128):609-13
9746022
Clin Exp Nephrol. 2014 Jun;18(3):424-31
23807430
Am Heart J. 2003 Dec;146(6):E23
14661012
Stat Med. 2002 Jun 15;21(11):1539-58
12111919
Rev Esp Cardiol. 2010 Jan;63(1):12-9
20089221
Semin Nephrol. 2001 Jan;21(1):36-46
11172557
Am J Med. 1997 Nov;103(5):368-75
9375704
N Engl J Med. 2000 Jul 20;343(3):180-4
10900277
Nephrol Dial Transplant. 2007 Jul;22(7):1873-81
17400565
Cardiovasc Intervent Radiol. 2006 May-Jun;29(3):344-7
16502177
Am Heart J. 2004 Sep;148(3):422-9
15389228
J Clin Diagn Res. 2014 Dec;8(12):HC03-7
25653965
Trials. 2009 Jun 29;10:45
19563648
J Interv Cardiol. 2004 Jun;17(3):159-65
15209578
J Cardiol. 2010 Mar;55(2):174-9
20206069
J Vasc Surg. 2004 Dec;40(6):1136-41
15622367
Am Heart J. 2004 Oct;148(4):690-5
15459602
Kidney Int. 2003 Dec;64(6):2182-7
14633141
Ren Fail. 2015 Nov;37(10):297-303
26458505
Control Clin Trials. 1986 Sep;7(3):177-88
3802833
JACC Cardiovasc Interv. 2012 Jan;5(1):98-104
22230155
Acta Cardiol. 2003 Dec;58(6):555-60
14713182
J Invasive Cardiol. 2013 Jun;25(6):276-83
23735352
Am Heart J. 2006 May;151(5):1032.e9-12
16644332
Intern Med. 2011;50(7):673-7
21467697
Lancet. 2014 May 24;383(9931):1814-23
24856027
N Engl J Med. 2006 Jun 29;354(26):2773-82
16807414
Circulation. 2002 May 14;105(19):2259-64
12010907
Ann Intern Med. 2016 Mar 15;164(6):406-16
26830221
JAMA. 2006 Jun 21;295(23):2765-79
16788132
Catheter Cardiovasc Interv. 2012 May 1;79(6):921-6
21542122
Kidney Int Suppl. 2006 Apr;(100):S46-50
16612401
J Invasive Cardiol. 2005 Feb;17 (2):80-4
15687530
JAMA. 2003 Feb 5;289(5):553-8
12578487
N Engl J Med. 1995 Mar 9;332(10):647-55
7845430
Coron Artery Dis. 2012 Jun;23(4):265-70
22343798
Am J Physiol Renal Physiol. 2008 Apr;294(4):F719-28
18256310
Coron Artery Dis. 2014 Mar;25(2):111-7
24365793
Wien Klin Wochenschr. 2012 May;124(9-10):312-9
22527829
Clin Cardiol. 2010 Mar;33(3):E63-8
20127900
Intern Med. 2012;51(19):2709-14
23037460
Ann Emerg Med. 2013 Nov;62(5):511-520.e25
23769807
J Am Coll Cardiol. 2004 Oct 6;44(7):1393-9
15464318
Ann Vasc Surg. 2007 Sep;21(5):593-7
17823041
Am J Cardiol. 2002 Feb 1;89(3):356-8
11809444
Saudi J Kidney Dis Transpl. 2016 Jan;27(1):55-61
26787567
Circ Cardiovasc Interv. 2014 Apr;7(2):216-24
24714489
Nephrol Dial Transplant. 2009 Oct;24(10):3103-7
19549691
Stat Med. 2011 Nov 10;30(25):2967-85
21826697
Clin Cardiol. 2012 Apr;35(4):250-4
22262230
Clin Res Cardiol. 2007 Mar;96(3):130-9
17180572
J Am Coll Cardiol. 2008 Apr 15;51(15):1419-28
18402894
J Am Coll Cardiol. 2002 Oct 16;40(8):1383-8
12392825
Saudi J Kidney Dis Transpl. 2014 Nov;25(6):1217-23
25394438
Am J Physiol. 1997 Mar;272(3 Pt 2):F292-8
9087670
Eur Heart J. 2008 Oct;29(20):2569-76
18468994
Kidney Int. 2002 Dec;62(6):2202-7
12427146
Eur J Clin Invest. 2009 Sep;39(9):793-9
19500141
J Am Coll Cardiol. 2010 May 18;55(20):2201-9
20466200
Heart. 2005 Jun;91(6):774-8
15894775
Circulation. 2011 Sep 13;124(11):1250-9
21859972
J Am Coll Cardiol. 2003 Jun 18;41(12 ):2114-8
12821233
Nephrol Dial Transplant. 2008 Apr;23 (4):1241-5
18174269
Int Urol Nephrol. 2013 Oct;45(5):1309-18
23283594
Eur Heart J. 2004 Feb;25(3):212-8
14972421
Am J Nephrol. 2009;29(3):181-91
18781062
Int Urol Nephrol. 2014 Sep;46(9):1801-7
24966097
Am J Physiol. 1990 Jan;258(1 Pt 2):F115-20
2301588
J Am Coll Cardiol. 2002 Jul 17;40(2):298-303
12106935
BMJ. 1997 Sep 13;315(7109):629-34
9310563
PLoS One. 2013;8(1):e55124
23383076
Ann Intern Med. 2008 Feb 19;148(4):284-94
18283206
AJR Am J Roentgenol. 2007 Sep;189(3):687-92
17715118
Int J Cardiol. 2012 Mar 22;155(3):418-23
21106264
J Interv Cardiol. 2013 Feb;26(1):90-6
22994682
Int J Cardiol. 2010 Feb 4;138(3):239-45
18793808
J Cardiovasc Pharmacol. 2005 Oct;46(4):464-7
16160598
Angiology. 2011 Apr;62(3):225-30
20682612
Heart Lung Circ. 2005 Dec;14 (4):245-51
16360994
Catheter Cardiovasc Interv. 2002 Nov;57(3):279-83
12410497
Catheter Cardiovasc Interv. 2003 Dec;60(4):458-61
14624421
Eur J Anaesthesiol. 2010 Nov;27(11):973-7
20299984
Clin Res Cardiol. 2011 Nov;100(11):1037-43
21710343
N Engl J Med. 2000 Jul 20;343(3):210-2
10900284
Am J Kidney Dis. 2004 May;43(5):801-8
15112170
Int J Cardiol. 2007 Jan 31;115(1):57-62
16814414
Heart Lung. 2007 May-Jun;36(3):195-204
17509426