The effectiveness of N-acetylcysteine in preventing contrast-induced nephropathy in patients undergoing contrast-enhanced computed tomography: a meta-analysis of randomized controlled trials

• Published in: International urology and nephrology 2013-10, Vol.45 (5), p.1309-1318
• Main Authors: Wu, Mei-Yi, Hsiang, Hui-Fen, Wong, Chung-Shun, Yao, Min-Szu, Li, Yun-Wen, Hsiang, Chao-Ying, Bai, Chyi-Huey, Hsu, Yung-Ho, Lin, Yuh-Feng, Tam, Ka-Wai
• Format: Article
• Language: English
• Subjects: Acetylcysteine - therapeutic use; Acute Kidney Injury - chemically induced; Acute Kidney Injury - physiopathology; Acute Kidney Injury - prevention & control; Acute Kidney Injury - therapy; Contrast Media - adverse effects; Creatinine - blood; Cystatin C - blood; Fluid Therapy; Free Radical Scavengers - therapeutic use; Glomerular Filtration Rate; Humans; Medicine; Medicine & Public Health; Nephrology; Nephrology - Original Paper; Randomized Controlled Trials as Topic; Renal Dialysis; Tomography, X-Ray Computed; Urology
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-012-0363-1

Background N -Acetylcysteine (NAC) is reported to have potential for preventing of contrast-induced nephropathy (CIN) in patients undergoing coronary angiography. However, the effectiveness of NAC in preventing CIN in patients undergoing contrast-enhanced computed tomography (CT) is still controversial. We conducted a meta-analysis of relevant randomized controlled trials (RCTs) to further examine this issue. Methods RCTs were identified by computerized searching in PubMed, EMBASE, SCOPUS, and Cochrane databases. Two reviewers independently assessed the methodological quality of each study. A meta-analysis was performed to evaluate the effectiveness of NAC in preventing CIN in patients undergoing CT. The primary outcome was the incidence of contrast-induced nephropathy, and the requirement for dialysis. The secondary outcome was the change of serum creatinine. Results Six randomized controlled trials were identified with a total of 496 patients meeting the criteria for this study. Prophylactic administration of NAC in patients with serum creatinine above 1.2 mg/dL undergoing contrast-enhanced CT, along with hydration, reduced the risk of CIN (relative risk 0.20; 95 % confidence interval: 0.07–0.57). Requirement for dialysis was not significantly different between the NAC group and the control group. Conclusions This review provides evidence of the efficacy of NAC in preventing the incidence of CIN and recommends that NAC be more widely used in high-risk patients undergoing contrast-enhanced CT. On the basis of the evidence reviewed, further research involving large RCTs may be warranted.