Oral N-acetylcysteine for prophylaxis of contrast-induced nephropathy in patients following coronary angioplasty: A meta-analysis

Abstract

It is acknowledged that contrast-induced nephropathy (CIN) is a common cause of acute renal insufficiency after cardiac catheterization and affects mortality and morbidity. To date, it is unknown whether oral N-acetylcysteine (NAC) is able to prevent contrast-induced nephropathy (CIN) in patients undergoing coronary angioplasty. A meta-analysis of randomized controlled trials was performed to assess the effects of NAC in the prevention of CIN in patients following coronary angioplasty. A total of 19 studies published prior to January 2015 that investigated the efficacy of oral NAC for the prevention of CIN were collected from Medline, Cochrane and Embase databases and conference proceedings from cardiology and nephrology meetings. The primary point of investigation was CIN, and the secondary points were renal failure requiring dialysis, mortality and length of hospitalization. The meta-analysis was performed using fixed- or random-effect models according to heterogeneity. Up to January 2015, 19 randomized placebo-controlled clinical trials met the inclusion criteria for the meta-analysis, including 4,514 patients. The pooled data showed that oral NAC did not reduce the CIN incidence [relative risk 0.84, 95% confidence interval (CI) 0.65–1.10; P=0.20], without heterogeneity among trials (I2=29%). Thus, the present meta-analysis suggests that oral NAC therapy is not effective as an alternative treatment to prevent CIN in patients following angioplasty. Further high quality randomized clinical controlled trials are required to confirm the usage and availability of this treatment.

Optimal antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: A systemic review and meta-analysis

“…Two investigators independently extracted data on patient and study characteristics, exposure factors, outcomes and study quality for each study using a standard data extraction form ( 33 ). Consensus with the third reviewer resolved any discrepancies.…”

Deleterious Effect of Urografin on the Renal Tubules of Adult Albino Rats and the Possible Protective Effect of N-Acetylcysteine Light and Electron Microscopic Study

“…2. Group II (NAC group): consisted of 4 rats receiving N-Acetylcysteine (Acetylcysteine effervescent) in a dose equivalent to the human dose twice daily by orogastric gavage for 3 days [13] .…”

“…Group IV (UG + NAC group): consisted of 8 rats received N-Acetylcysteine (NAC) the same as group II. Then , Urografin was injected the same as in group III and NAC was administered again twice for the next 24 hours after Urografin injection [13,18] .…”

“…Oral administration of the antioxidant N-Acetylcysteine (NAC) reduces the possibility of acute contrast-mediainduced nephropathy [7,13,14] . It has a strong antioxidant effects due to the ability of scavenging free reactive oxygen radicals which explain its reno-protective effects [15] .…”

Contrast-Induced Nephropathy: Update on the Use of Crystalloids and Pharmacological Measures

“…The limitations of the analysis were discussed in detail; most importantly, event rates were comparably low, and the distribution of participants among treatment strategies was quite heterogenous. Li and colleagues finally published another meta-analysis in August 2017 [ 43 ]. A total number of 19 clinical trials with more than 4.000 individuals was evaluated, concluding that ACC is not an effective strategy for CIN prophylaxis.…”