Effectiveness of N ‐Acetylcysteine for the Prevention of Contrast‐Induced Nephropathy: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Abstract

BackgroundConflicting 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.Methods and ResultsPubMed, 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).ConclusionsOur 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.

Quercetin protects against radiocontrast medium toxicity in human renal proximal tubular cells

“…It has been proposed that the toxic effects of RCM could be due to oxidative stress and subsequent generation of reactive oxygen species (ROS) (Andreucci, Solomon, & Tasanarong, ; Pisani et al, ) and changes in intracellular signaling pathways, including the upregulation of cell signaling molecules that have been implicated in cell death/inflammation, such as the JNKs (Andreucci, ; Andreucci et al, ; Andreucci, Faga, Russo et al, ; Lee, Sheu, Yen, Lai, & Chang, ). The use of the antioxidant N‐acetylcysteine to alleviate the effects of RCM has yielded conflicting results (Investigators, ; Xu, Tao, Bai, Deng, & Chen, ), although other naturally occurring antioxidants, such as α‐ and γ‐tocopherol (vitamin E) have been reported to offer some benefit (Tasanarong, Vohakiat, Hutayanon, & Piyayotai, ). In the present study, we set out to investigate the effect of quercetin on the toxic effects of radiocontrast media (RCM) on human proximal tubular renal cells in vitro.…”

An experimental study on the preventive effects of N-acetyl cysteine and ozone treatment against contrast-induced nephropathy

“…Moreover, reactive oxygen species linked with the introduction of a contrast agent can contribute to the progression of CIN. Reactive oxygen species may have both direct and indirect roles on the cortical and medullary microcirculation 8 . CIN has become a more important problem since its incidence has increased attributed to the recent popularization of diagnostic and interventional radiologic procedures 9 .…”

The Diagnostic Value of HIF-2 Alpha to Determine The Development and Efficacy of Treatment for Contrast Induced Nephropathy: An Experimental Study

“…CIN is one the most important causes of acute renal damage/injury in patients followed at emergency services and inpatients [2]- [4]. In the current literature, the rates for CIN was reported between 0.2-2.0%, after tomography undertaken with contrast agents [1].…”

“…Contrast-induced nephropathy (CIN) is an acute renal damage due to the use of contrast agents. The diagnosis is made with the 25% increment or 5 mg/dL increase of serum creatinine (Scr) versus basal levels within the 48 hours of contrast agent use [1].…”

“…Except volume therapies, there is no consensus or an exact protocol for the use in emergency services. N-acetyl cysteine (NAC) is commonly used for the treatment of CIN [1]. Besides, in recent years sildenafil is determined to be effective in experimental CIN models [15].…”