N-Acetylcysteine and contrast-induced nephropathy: A meta-analysis of 13 randomized trials

New guidelines on the use of iodinated contrast media: a report on an implementation project

“…Il fatto che il rischio di nefropatia da MdC può essere più alto in caso the procedure [18]. The usefulness of N-acetylcysteine in preventing contrast-induced nephropathy [19] is still being debated in the literature; however, until conclusive evidence becomes available, we believe it reasonable to continue its use, as it is inexpensive, simple to administer and free of side effects. If necessary, the nephrologist requests serum creatinine testing after the examination (at 12, 24, 36 or 48 di somministrazione intra-arteriosa del mezzo di contrasto [15] [18].…”

“…If necessary, the nephrologist requests serum creatinine testing after the examination (at 12, 24, 36 or 48 di somministrazione intra-arteriosa del mezzo di contrasto [15] [18]. In letteratura l'utilità dell'acetilcisteina per la prevenzione della nefropatia da MdC è assai controverso [19] h); a 25% increase in serum creatinine within 3 days after contrast administration is considered to be contrast-induced nephropathy [20]. In addition, to prevent possible lactic acidosis [21], diabetic patients receiving metformin are instructed to discontinue the medication 48 h before and not resume it until 48 h after the examination, after renal function has been evaluated.…”

Prevenção de nefrotoxicidade por contraste com solução de bicarbonato: resultados preliminares e revisão da literatura

“…Intravenous hydration with 0.9% SS) 0.9% SS 1 mL/kg/h, 12 hours before and 12 hours after the procedure Several randomized studies and metaanalyses 30,[32][33][34] 0.9% SS is superior to 0.45% SS 23,32 Sodium bicarbonate (154 mEq/L) NaHCO3 3 mL/kg/h, 1 hour before the procedure and 1 mL/kg/h, 6 hours after the procedure Several randomized studies and meta-analyses 32,[49][50][51][52][53][54] Dilute 154 mL of 8.4% sodium bicarbonate in 846 mL of distilled water for obtaining the solution Type of contrast medium Low-osmolality or iso-osmolality contrast medium Some randomized studies and a few meta-analyses [26][27][28] The literature is still controversial whether isoosmolality contrast medium is superior to low-osmolality contrast medium 29 N-acetyl cysteine 600 mg, orally, 12/12 hours, 24 hours before and after the procedure Still controversial 54,55 Large ongoing multicenter study 56 …”

“…54 Other meta-analyses studying N-acetyl cysteine provided conflicting results, making the real efficacy of using that drug for preventing CN questionable. 54,55 It is worth noting the existence of an ongoing Brazilian randomized, controlled, multicenter trial (2,300 patients) using either N-acetyl cysteine, 600 mg, orally, every 12 hours (two doses before and two doses after the contrast-enhanced procedure) or placebo, in patients undergoing angiography. The initial endpoint is the occurrence of CN, defined as a 25% increase in baseline creatinine, within 48 to 96 hours after the exam.…”

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

“…Because animal studies have indicated that NAC may protect the myocardium and preserve kidney function [128], it was expected to prevent CIN in humans. After the report by Tepel et al [65] on the effect of NAC (600 mg twice daily, orally) in preventing CIN, many RCTs and meta-analyses were conducted [129][130][131][132][133][134][135][136][137][138][139].…”