<i>N</i>‐acetylcysteine versus <i>N</i>‐acetylcysteine + theophylline for the prevention of contrast nephropathy

Başkurt, Murat; Ökçün, Barış; Abacı, Okay; Dogan, G M; Kılıçkesmez, Kadriye Orta; Özkan, Alp; Ersanlı, Murat; Gürmen, Tevfik

doi:10.1111/j.1365-2362.2009.02173.x

Cited by 27 publications

(16 citation statements)

References 53 publications

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“…Forty-eight eligible RCTs15–62 enrolled 14 709 patients with CKD undergoing CAG±PCI. Figure 1 shows the results of the search and the number of citations at different stages of the selection process.…”

Section: Resultsmentioning

confidence: 99%

Pharmacological interventions for the prevention of contrast-induced acute kidney injury in high-risk adult patients undergoing coronary angiography: a systematic review and meta-analysis of randomised controlled trials

et al. 2019

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ObjectiveQuantify the efficacy of strategies to prevent contrast-induced acute kidney injury (CI-AKI) in high-risk patients undergoing coronary angiography (CAG) with or without percutaneous coronary intervention (PCI).BackgroundCI-AKI remains a common problem. The renoprotective efficacy of existing pharmacological agents remains uncertain in high-risk populations.MethodsSystematic review and meta-analysis of randomised controlled trials (RCTs) to compare different strategies versus hydration in patients with chronic kidney disease (CKD) undergoing CAG±PCI. Primary outcome was incident CI-AKI. Fixed-effects meta-analyses estimated ORs, 95% CIs and heterogeneity.ResultsForty-eight RCTs were included. Seven pharmacological strategies were evaluated by multiple RCTs and 10 by one RCT each. These had varying risk of bias; >25% of trials were at high risk of performance bias. Five strategies significantly reduced the odds of CI-AKI: N-acetylcysteine (NAC) (27 trials, 5694 participants; OR=0.77, 95% CI 0.65 to 0.91, p=0.002, I2=36%), ascorbic acid (four trials, 759 participants; OR=0.59, 95% CI 0.39 to 0.89, p=0.01, I2=0%), statin (two trials, 3234 participants; OR=0.59, 95% CI 0.39 to 0.89, p=0.75, I2=0%), trimetazidine (two trials, 214 participants; OR=0.27, 95% CI 0.10 to 0.71, p=0.01, I2=0%) and nicorandil (two trials, 389 participants; OR=0.47, 95% CI 0.23 to 0.94, p=0.03, I2=52%). Theophylline had a similar, but non-significant, effect. A subgroup analysis found that the benefit of NAC was highest in patients requiring a high-contrast dose.ConclusionsSeveral drugs are renoprotective in patients with CKD undergoing CAG±PCI. The evidence is strongest for NAC. We recommend that NAC should be used when a high dose of contrast is anticipated.Trial registration numberPROSPERO registration CRD42014014704.Open Science Framework link: https://osf.io/vxg7d/?view_only=62bad0404b18405abd39ff2ead2575a8

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Section: Resultsmentioning

confidence: 99%

Pharmacological interventions for the prevention of contrast-induced acute kidney injury in high-risk adult patients undergoing coronary angiography: a systematic review and meta-analysis of randomised controlled trials

et al. 2019

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“…The incidence of CI-AKI was lower in theophylline group compared to saline group. Moreover, these studies showed comparable [109, 111] or even more preferable [110, 112] results of theophylline than NAC. However, Abizaid et al [101] randomized 60 patients into 3 groups: (1) aminophylline with saline, (2) saline alone, and (3) dopamine with saline.…”

Section: Pharmacological Strategies To Prevent Ci-akimentioning

confidence: 96%

Pharmacological Strategies to Prevent Contrast-Induced Acute Kidney Injury

Pattharanitima

Tasanarong

2014

BioMed Research International

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Contrast-induced acute kidney injury (CI-AKI) is the most common iatrogenic cause of acute kidney injury after intravenous contrast media administration. In general, the incidence of CI-AKI is low in patients with normal renal function. However, the rate is remarkably elevated in patients with preexisting chronic kidney disease, diabetes mellitus, old age, high volume of contrast agent, congestive heart failure, hypotension, anemia, use of nephrotoxic drug, and volume depletion. Consequently, CI-AKI particularly in high risk patients contributes to extended hospitalizations and increases long-term morbidity and mortality. The pathogenesis of CI-AKI involves at least three mechanisms; contrast agents induce renal vasoconstriction, increase of oxygen free radicals through oxidative stress, and direct tubular toxicity. Several strategies to prevent CI-AKI have been evaluated in experimental studies and clinical trials. At present, intravascular volume expansion with either isotonic saline or sodium bicarbonate solutions has provided more consistent positive results and was recommended in the prevention of CI-AKI. However, the proportion of patients with risk still develops CI-AKI. This review critically evaluated the current evidence for pharmacological strategies to prevent CI-AKI in patients with a risk of developing CI-AKI.

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“…Theophylline has been more commonly used for chronic obstructive pulmonary disease and now has been evaluated for increasing blood pressure and renal blood flow. The combination of oral N-acetylcysteine and theophylline in conjunction with normal saline hydration has been shown to reduce CI-AKI over that of normal saline or normal saline therapy with N-acetylcysteine: RR of 0.48 (95% CI, 0.41-0.57) and RR of 0.49 (95% CI, 0.40-0.57), respectively [20]. A similar randomized controlled trial has shown the efficacy of theophylline added to a sodium bicarbonate protocol to significantly reduce CI-AKI: RR of 0.61 (95% CI, 0.48-0.78) [21].…”

Section: Combination Therapymentioning

confidence: 97%

Contrast-Induced Acute Kidney Injury: The At-Risk Patient and Protective Measures

Brown

Thompson

2010

Curr Cardiol Rep

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Contrast-induced acute kidney injury (CI-AKI) is a major complication following radiocontrast procedures. In this review, we characterize the recent literature on CI-AKI, risk factors, prevention, biomarkers, and new technologies. The premise of CI-AKI prophylaxis should focus on implementing mandatory standing orders before and after cardiac catheterization for hydration with normal saline or sodium bicarbonate and use of high-dose (1200-mg) N-acetylcysteine. Contrast agents may play a role in preventing CI-AKI. Implement catheter-laboratory technology and awareness to limit the amount of contrast dye used for any patient.

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N‐acetylcysteine versus N‐acetylcysteine + theophylline for the prevention of contrast nephropathy

Abstract: Among patients with eGFR between 30 and 60 mL min(-1) 1.73 m(-2) undergoing coronary angiography, oral administration of N-acetylcysteine + theophylline in addition to saline hydration has a beneficial effect in the prevention of CIN.

Cited by 27 publications

References 53 publications

Pharmacological interventions for the prevention of contrast-induced acute kidney injury in high-risk adult patients undergoing coronary angiography: a systematic review and meta-analysis of randomised controlled trials

Pharmacological interventions for the prevention of contrast-induced acute kidney injury in high-risk adult patients undergoing coronary angiography: a systematic review and meta-analysis of randomised controlled trials

Pharmacological Strategies to Prevent Contrast-Induced Acute Kidney Injury

Contrast-Induced Acute Kidney Injury: The At-Risk Patient and Protective Measures

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