N-acetyl cysteine versus allopurinol in the prevention of contrast nephropathy in patients with chronic kidney disease: A randomized controlled trial

Abstract

Contrast media administration can lead to acute deterioration in renal function particularly in patients with pre-existing chronic kidney disease. This prospective, randomized controlled open-label parallel group study was undertaken at Nizam's Institute of Medical Sciences, Hyderabad, from June to December 2015. A total of 95 patients were included, of which 35 received n-acetylcysteine (NAC) + normal saline (NS), 30 patients received allopurinol (ALL) + NS, and 30 patients received placebo. In our study, the overall incidence of CIN was 24%. Incidence of CIN in NAC + NS, ALL + NS, and placebo group were 20%, 16%, and 36%, respectively. The major finding of this study was there was no significant difference between NAC and allopurinol in the prevention of contrast nephropathy. However, only allopurinol was superior to placebo. In our study, hyperuricemia and baseline serum creatinine were the only risk factors associated with CIN.

Meta-analysis on allopurinol preventive intervention on contrast-induced acute kidney injury with random controlled trials

“…Two studies [6,10] did not report the mean and standardized deviation of post-procedural Scr, the increase in Scr level from baseline are adopted instead according to the Cochrane Handbook for Systematic Reviews of Interventions. One study had more than 2 arms of studied groups, [10,11] which had 3 arms (hydration, hydration+n-acetylcysteine, hydration+allopurinol300 mg). We took the hydration arm as control group and took hydration+allopurinol300 mg arm as one experimental group.…”

“…Among those eight RCTs, 2 [13,14] enrolled patients with hyperuricemia has been associated with renal failure for a long time; 5 [5–7,11,12] enrolled patients with impaired renal function (Scr≥1.1 mg/dL;eGFR:30–59 mL/min/ 1.73 m 2 ;eGFR: >60 mL/min/ 1.73 m 2 ; Scr≥2.0 mg/dL; respectively); One study [10] included patients willing to complete the angiography and angioplasty with or without risk factors and patients with modies, there was insufficient information about some items to permit a definite judgment. Risk-generating information on the random sequence developing CI-AKI were included in 1 study.…”

“…[5,7,14] One RCT [6] were double blinded, three studies were open label. [7,10,11] No other potential sources of bias was apparently presented except one study. [12] As shown in Figure 3.…”

“…There were no statistical differences in the baseline Scr and cystatin-c between allopurinol groups and controlled groups in all included studies except 2 studies (not reported). [10,11] This meta-analyses of the post-procedural Scr differences between allopurinol and controlled groups at 24 or 48 hours using a random effects model. The changes of post-procedural Scr concentration reflected the protection effect of allopurinol therapy in patients after contrast administration.…”

Effect of allopurinol in the prevention of contrast-induced nephropathy in patients undergoing angioplasty: randomized clinical trial

“…The study by Iranirad et al 13 revealed that CIN was present in 11.4 % and 15.7 % in the allopurinol and control groups, respectively and then, they concluded that allopurinol could have no considerable effect on the efficient hydration due to the prevntion of CIN in the high-risk patients. Sadineni et al 14 compared three groups who were receiving N-Acetyl-Cysteine (NAC), allopurinol, and placebo and they reported 20, 16, and 36% rates for CIN in respectively NAC, allopurinol, and placebo groups, demonstrating a significant difference between the allopurinol and placebo groups. Moreover, they similarly reported remarkable consequences of hyperuricemia in the development of CIN.…”