<i>N</i>-acetylcysteine for the prevention of contrast-induced nephropathy in patients with pre-existing renal insufficiency or diabetes: a systematic review and meta-analysis

Kang, Xin; D, Hu; Li, Chang-Bin; Ai, Zisheng; Peng, Ai

doi:10.3109/0886022x.2015.1012985

Cited by 39 publications

(22 citation statements)

References 44 publications

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“…The authors of the meta-analysis concluded that N-acetylcysteine can be administered in CI-AKI prevention. However, because of the contradictory results reported in different studies, providing definite proof of this argument requires further research (11). Our findings are in some ways similar to the above results.…”

Section: Discussionsupporting

confidence: 88%

The standard dose versus double dose of N-acetylcysteine to prevent contrast-induced nephropathy; a randomized controlled clinical trial

Eskandarian¹,

Yarmohamadi²,

Zaker-Tavalae³

et al. 2018

J Nephropathol

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Background: Contrast-induced acute kidney injury (CI-AKI) is one of the possible complications in angiography, which its prevention is important. N-acetylcysteine is one of the compounds that has recently been more investigated regarding its effect on CI-AKI. Objectives: The aim of this study was to investigate the effect of standard dose and twice-thestandard of N-acetyl cysteine on prevention of contrast-induced nephropathy. Patients and Methods: In a clinical trial, 154 individuals who were referred for angiography and had glomerular filtration rate (GFR) ≤60 mL/min, enrolled in and randomly divided into two groups. Group A received the usual dose of N-acetyl cysteine and group B received twice the standard. Blood urea nitrogen (BUN), creatinine, and GFR values were measured and recorded at intervals before, 24, 48 and 72 hours after angiography. Other required laboratory parameters were also measured and recorded. Results: The results of this study indicated that the effect of double dose in males and females is not different. It also has a reverse effect on renal function in older patients. Its effect did not differ in diabetic patients compared to non-diabetic patients. N-acetyl cysteine in dose of twice the standard has not any effect on renal function in patients with hyperlipidemia, hypertension, myocardial infarction, pulmonary edema as well as smoker patients. In patients with congestive heart failure (CHF), N-acetyl cysteine in dose of twice the standard had a positive effect on renal function compared with those who did not have CHF. An interesting point in our study was the negative effect of N-acetyl cysteine in dose of twice-the-standard on renal function in patients with lower hemoglobin and hematocrit levels. Conclusions: Our study showed that an increase in the dose of N-acetyl cysteine is not effective in preventing contrast-induced nephropathy and improving renal function. Of course, in some groups, such as those with CHF, a positive effect was detected. Additionally, in some groups including patients with lower hematocrit and hemoglobin, an increase in dose is associated with a negative effect on renal function. ABSTRACT Implication for health policy/practice/research/medical education:In a clinical trial, on 154 individuals who were referred for angiography or angioplasty and have glomerular filtration rate (GFR) ≤ 60 CC/min showed that an increase in the dose of N-acetyl cysteine is not effective in preventing contrast-induced nephropathy and improving renal function. Please cite this paper as: Eskandarian R, Yarmohamadi M, Zaker-Tavalae M, Mirmohammadkhani M, Biglari M, Tamadon MR, et al. The standard dose versus double dose of N-acetylcysteine to prevent contrast-induced nephropathy; a randomized controlled clinical trial.

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Section: Discussionsupporting

confidence: 88%

The standard dose versus double dose of N-acetylcysteine to prevent contrast-induced nephropathy; a randomized controlled clinical trial

Eskandarian¹,

Yarmohamadi²,

Zaker-Tavalae³

et al. 2018

J Nephropathol

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“…Most recent RCTs or meta-analyses do not show a protective effect of NAc against PC-AKI following coronary or peripheral angiography [ 66 , 80 – 84 ]. NAc also failed to affect clinical outcome in coronary or peripheral angiography [ 85 ] or to have a protective effect in CT [ 86 , 87 ] or in patients with diabetes mellitus undergoing coronary or peripheral angiography [ 88 , 89 ]. Comparative studies with NAc combined with saline or sodium bicarbonate protocols did not show any additional effect of protective effect of NAc [ 61 , 90 – 93 ].…”

Section: Resultsmentioning

confidence: 99%

Post-contrast acute kidney injury. Part 2: risk stratification, role of hydration and other prophylactic measures, patients taking metformin and chronic dialysis patients

et al. 2018

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ObjectivesThe Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers.Areas covered in part 2Topics reviewed include stratification of PC-AKI risk, the need to withdraw nephrotoxic medication, PC-AKI prophylaxis with hydration or drugs, the use of metformin in diabetic patients receiving contrast medium and the need to alter dialysis schedules in patients receiving contrast medium.Key points • In CKD, hydration reduces the PC-AKI risk • Intravenous normal saline and intravenous sodium bicarbonate provide equally effective prophylaxis • No drugs have been consistently shown to reduce the risk of PC-AKI • Stop metformin from the time of contrast medium administration if eGFR < 30 ml/min/1.73 m 2 • Dialysis schedules need not change when intravascular contrast medium is given

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“…Previous studies suggested that NAC has no benefit in patients with normal serum creatinine levels [17]. The beneficial effect of NAC is mostly observed in patients with pre-existing renal dysfunction, particularly in cases of contrast-induced nephropathy [10,12].…”

Section: Discussionmentioning

confidence: 99%

Colistin-induced nephrotoxicity and the role of N-acetylcysteine: a retrospective cohort study

Bozkurt

Sharma

Esen

2017

J Infect Dev Ctries

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Introduction: Colistin is associated with dose-dependent nephrotoxicity. N-acetylcycteine (NAC) may reduce the risk of concomitant acute kidney injury (AKI) due to its antioxidant properties. We report a retrospective cohort study evaluating the role of N-acetylcysteine (NAC) in the development of colistin (COL) associated nephrotoxicity. Methodology: A single centre retrospective cohort study was conducted in a university hospital between January 2014 and June 2015. Nephrotoxicity was defined and staged per the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria. We evaluated the association between NAC use and COL-related nephrotoxicity by comparing the incidence of nephrotoxicity in patients receiving colistin with or without adjunctive NAC. Results: Forty-six patients received intravenous (IV) COL and 46 patients received IV NAC+COL. The cumulative COL doses did not differ between the two groups (p = 0.802). The initial creatinine value doubled in 29 (63%) patients undergoing NAC+COL therapy and in 27 (58.7%) patients in the COL group (p = 0.669). The median doubling time of baseline creatinine was 6 and 7 days in the NAC+COL and COL groups, respectively. The mean hospital stay, potentially nephrotoxic agent use, and mortality rates were statistically higher for the patients receiving NAC+COL (p < 0.005). Conclusions: The present study was not able to reveal any beneficial effect of NAC for patients undergoing COL therapy. The NAC+COL group had a higher baseline risk for development of AKI. However, the incidence of AKI was comparable between the groups. The results of the study would not solely exhibit the protective effect of adjunctive NAC therapy.

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N-acetylcysteine for the prevention of contrast-induced nephropathy in patients with pre-existing renal insufficiency or diabetes: a systematic review and meta-analysis

Cited by 39 publications

References 44 publications

The standard dose versus double dose of N-acetylcysteine to prevent contrast-induced nephropathy; a randomized controlled clinical trial

The standard dose versus double dose of N-acetylcysteine to prevent contrast-induced nephropathy; a randomized controlled clinical trial

Post-contrast acute kidney injury. Part 2: risk stratification, role of hydration and other prophylactic measures, patients taking metformin and chronic dialysis patients

Colistin-induced nephrotoxicity and the role of N-acetylcysteine: a retrospective cohort study

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