Oral N-acetylcysteine administered immediately prior to routine percutaneous coronary procedures ameliorates contrast-induced nephrotoxicity

Nogareda, Gustavo; Ricci, Donald R.; Penn, I; Huckell, Victor F.; Fox, Rebeca; Chow, Jackie; Eichman, Anne; Buller, Christopher E.

doi:10.1016/s0735-1097(03)80883-5

Cited by 5 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ten studies were retrospective [ 32 - 41 ]. Three studies were prospective but not randomized [ 42 - 44 ]. Five studies were removed owing to a lack of placebo controls [ 45 - 49 ].…”

Section: Resultsmentioning

confidence: 99%

A meta-analysis of N-acetylcysteine in contrast-induced nephrotoxicity: unsupervised clustering to resolve heterogeneity

Gonzales

Norsworthy

Kern

et al. 2007

BMC Med

137

View full text Add to dashboard Cite

show abstract

“…Ten studies were retrospective [ 32 - 41 ]. Three studies were prospective but not randomized [ 42 - 44 ]. Five studies were removed owing to a lack of placebo controls [ 45 - 49 ].…”

Section: Resultsmentioning

confidence: 99%

A meta-analysis of N-acetylcysteine in contrast-induced nephrotoxicity: unsupervised clustering to resolve heterogeneity

Gonzales

Norsworthy

Kern

et al. 2007

BMC Med

137

View full text Add to dashboard Cite

show abstract

“…Investigation of publication bias, heterogeneity, and meta-regression was performed on these 16 studies. We sought further clarification of presented data in four cases (5,6,10,11). Tables 1 and 2 list important study and subject characteristics of the 16 prospective controlled trials with a total of 1538 subjects.…”

Section: Resultsmentioning

confidence: 99%

“…The extracted information included the following: definition of radiocontrast-induced nephropathy, number of patients at initiation of study, average patient age, prevalence of diabetes and congestive heart failure, average baseline SCr concentration, hydration protocol, total hydration volume, weight before and after administration to assess hydration status, type of radiocontrast medium, average volume of radiocontrast medium, dose of N-acetylcysteine, timing of N-acetylcysteine administration, change in SCr concentration after 48 h, incidence of radiocontrast-induced nephropathy (as defined below), and the proportion of individuals needing dialysis. Information that was not clearly presented within the body of the article or abstract was clarified by contacting the primary investigators (5,6,10,11).…”

Section: Data Analysesmentioning

confidence: 99%

“…Journal of the American Society of Nephrology J Am Soc Nephrol 15: [761][762][763][764][765][766][767][768][769] 2004 The two studies were excluded because they used retrospective controls (17,18). Investigation of publication bias, heterogeneity, and meta-regression was performed on these 16 studies.We sought further clarification of presented data in four cases (5,6,10,11). Tables 1 and 2 list important study and subject characteristics of the 16 prospective controlled trials with a total of 1538 subjects.…”

mentioning

confidence: 99%

See 1 more Smart Citation

N-Acetylcysteine for the Prevention of Radiocontrast Induced Nephropathy

Kshirsagar¹,

Poole²,

Mottl³

et al. 2004

Journal of the American Society of Nephrology

209

View full text Add to dashboard Cite

Abstract. N-acetylcysteine has been recommended for patients with renal insufficiency who are to receive radiocontrast media. However, trials of oral N-acetylcysteine for the prevention of radiocontrast-induced nephropathy have yielded inconsistent results. A systematic review of patient and study characteristics was undertaken to discover possible explanations of the inconsistencies. The databases MEDLINE, EMBASE, and CENTRAL (1966 to March 2003) were searched in all languages, and conference proceedings from several professional societies from the years 1999 to 2003 were also searched. Only prospective controlled trials of oral N-acetylcysteine were included. Risk difference estimates and 95% confidence intervals were calculated. The estimates were examined for evidence of publication bias and heterogeneity. Stratified and meta-regression analyses were used to compare estimates by study and patient characteristics. Identified were 16 studies, 15 published and 1 unpublished. There was no evidence of publication bias, but there was substantial evidence of heterogeneity, thus precluding reliance on a meaningful summary effect estimate. Meta-regression identified several patient and study characteristics, with some evidence of association with study-specific estimates. None of these characteristics, however, formed subsets of studies with results that were homogeneous enough to aggregate. Research on N-acetylcysteine and the incidence of radiocontrast nephropathy is too inconsistent at present to warrant a conclusion on efficacy or a recommendation for its routine use. Identified patient and study characteristics may be responsible for some, but not all, of this inconsistency. A large, randomized, placebo-controlled trial, a pooled analysis of patient-level data, or both may resolve this issue.Over the last 3 yr, enthusiasm for the use of oral N-acetylcysteine to prevent radiocontrast-induced nephropathy has been growing (1). A breakthrough study (2) first reported a large and significant reduction in the risk of radiocontrast-induced nephropathy compared with placebo among patients with moderate renal dysfunction. Subsequent studies produced mixed results (3-6). Recently, a large study (7), arguably with a relatively high degree of power and sound methods, seemed to confirm the beneficial effect of this agent. N-acetylcysteine is now being routinely recommended as preventative therapy, as an additive to low-osmolar contrast media and intravenous hydration, for patients with reduced renal function who are to undergo a planned exposure to radiocontrast media (8,9). Yet the reasons for discrepant findings among the trials need investigation before the widespread use of N-acetylcysteine can be recommended.We therefore performed a systematic review and metaanalysis of available prospective controlled trials to quantify and compare reported associations of oral N-acetylcysteine with the incidence of nephropathy after exposure to radiocontrast media. For this review, we examined several key questions. Is there evidenc...

show abstract

“…We identified 34 references published between 2000 and 2004 that examined the role of NAC as prophylaxis for RCIN [8, 17–48, 69]. Twenty were published as original articles, 13 were in abstract form, and all but 1 were English language.…”

Section: Resultsmentioning

confidence: 99%

N‐acetylcysteine prophylaxis significantly reduces the risk of radiocontrast‐induced nephropathy: Comprehensive meta‐analysis

Duong

MacKenzie

Malenka

2005

Cathet Cardio Intervent

View full text Add to dashboard Cite

The objectives of this study was to assess the overall effect of N-acetylcysteine (NAC) in preventing radiocontrast-induced nephropathy (RCIN) using all available data in the literature. RCIN is associated with increased morbidity and mortality. Existing randomized trials of NAC are small and show inconsistent results. Prior meta-analyses do not include data from the most current studies. We used standard search protocols to identify all published articles and abstracts of prospective trials using NAC with fluid hydration compared to hydration alone in patients with chronic renal insufficiency undergoing contrast procedures. A rise in serum creatinine by 0.5 mg/dl or 25% above baseline at 48-72 hr after contrast exposure was used as the primary outcome. We identified 14 trials of NAC with 1,584 patients published as full-text articles. Using a random-effects model, the use of oral NAC resulted in a significant reduction in the risk for developing RCIN (RR = 0.57; 95% CI = 0.37-0.84; P = 0.01). This finding did not significantly change in a fixed-effect model (RR = 0.55; 95% CI = 0.42-0.73) or when the data were reanalyzed using only randomized trials in all forms (i.e., articles and abstracts; RR = 0.67; 95% CI = 0.47-0.95). We identified only one important difference between the positive and the negative studies: the cumulative exposure to contrast media (174 vs. 152 ml). Metaregression did not show a significant relationship between contrast volume and the RR of developing RCIN (P > 0.10). In the trials showing benefit for NAC, the treated patients' postprocedure creatinine unexpectedly decreased by 0.21 mg/dl (95% CI = 0.33-0.08). Prophylaxis with NAC significantly reduces the risk for RCIN. The reasons for improvement in serum creatinine in patients treated with NAC are unclear, but may include improved renal blood flow due to NAC and/or vigorous hydration.

show abstract

Oral N-acetylcysteine administered immediately prior to routine percutaneous coronary procedures ameliorates contrast-induced nephrotoxicity

Cited by 5 publications

References 0 publications

A meta-analysis of N-acetylcysteine in contrast-induced nephrotoxicity: unsupervised clustering to resolve heterogeneity

A meta-analysis of N-acetylcysteine in contrast-induced nephrotoxicity: unsupervised clustering to resolve heterogeneity

N-Acetylcysteine for the Prevention of Radiocontrast Induced Nephropathy

N‐acetylcysteine prophylaxis significantly reduces the risk of radiocontrast‐induced nephropathy: Comprehensive meta‐analysis

Contact Info

Product

Resources

About