The effectiveness of N-acetylcysteine in preventing contrast-induced nephropathy in patients undergoing contrast-enhanced computed tomography: a meta-analysis of randomized controlled trials

Wu, Mei‐Yi; Hsiang, Hui Fen; Wong, Chu‐Kwan; Yao, Ming; Li, Yun Wen; Hsiang, Chao Ying; Bai, Chyi‐Huey; Hsu, Yung‐Ho; Lin, Yuh‐Feng; Tam, Ka‐Wai

doi:10.1007/s11255-012-0363-1

Cited by 44 publications

(36 citation statements)

References 21 publications

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“…Here, we demonstrated that GRP78 silencing led to the decrease in GSC properties and rendered them more sensitive to irradiation treatment, indicating GRP78's role in contributing to GSC stemness. This notion is supported by a previous study where GRP78 up-regulation was correlated to irradiation resistance in breast cancer cells [35]. Here, our data indicated that GRP78 up-regulation was accompanied by the increased level of c-Myc and β-catenin expression and led to increased resistance towards irradiation.…”

Section: Discussionsupporting

confidence: 89%

Pterostilbene suppressed irradiation-resistant glioma stem cells by modulating GRP78/miR-205 axis

Huynh

Lin

Lee

et al. 2015

The Journal of Nutritional Biochemistry

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Section: Discussionsupporting

confidence: 89%

Pterostilbene suppressed irradiation-resistant glioma stem cells by modulating GRP78/miR-205 axis

Huynh

Lin

Lee

et al. 2015

The Journal of Nutritional Biochemistry

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“…They determined no difference between these protocols. However, one meta-analysis published in 2013 and evaluating NAC therapy in preventing CIN explicitly stated that NAC was more effective 23 Our study compared the effectiveness of all three prophylactic options in the context of more specific radiologic imaging in a more specific patient group. Although all patients used at least one prophylactic option in the form of a precontrast bolus and infusion for at least 6 hours after contrast, the high level of development of CIN development, proceeding to severe renal insufficiency and hemodialysis requirements in some of these cases, is a finding requiring close attention from emergency physicians experiencing indecision between the risk of development of CIN and diagnosing or excluding PE.…”

Section: Discussionmentioning

confidence: 98%

The High Risk of Contrast‐induced Nephropathy in Patients with Suspected Pulmonary Embolism Despite Three Different Prophylaxis: A Randomized Controlled Trial

Türedi

Erdem

Karaca

et al. 2016

Academic Emergency Medicine

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Objective: The objective was to compare the protective effects of N-acetylcysteine (NAC) plus normal saline (NS), sodium bicarbonate (NaHCO 3 ) plus NS, and NS alone in the prevention of contrast-induced nephropathy (CIN) after computed tomography pulmonary angiography (CTPA) in emergency patients.Methods: This study was planned as a randomized, controlled clinical research. Patients undergoing contrast-enhanced CTPA on suspicion of pulmonary embolism (PE) in the emergency department and with at least one risk factor for development of CIN were included in one of three different prophylaxis groups. The groups received 3 mL/kg intravenous (IV) NAC+NS or NaHCO 3 +NS solution or NS alone 1 hour before CTPA and 1 mL/kg IV per hour for a minimum of 6 hours after CTPA. CIN was evaluated as the primary outcome and moderate or severe renal insufficiency and in-hospital mortality as secondary outcomes.Results: A total of 257 patients were enrolled in the study. The total level of CIN development was 23.7% (61/257), the level of moderate and severe renal failure was 12.5% (32/257), and the in-hospital mortality rate was 12.8% (33/257). Rates of CIN development in the drug groups were 23.5% in the NAC group (20/ 85), 21.2% (18/85) in the NaHCO 3 group, and 26.4% in the NS group (23/87). Rates of development of moderate or severe renal insufficiency were 9.4% in the NAC group (8/85), 10.6% in the NaHCO 3 group (9/ 85), and 17.2% in the NS group (15/87). In-hospital mortality rates were 12.9% in the NAC group (11/85), 11.8% in the NaHCO 3 group (10/85), and 13.8% in the NS group (12/87). No difference was determined between the drug groups in terms of CIN, moderate or severe renal injury, or hospital mortality. Conclusions:Our results indicate that there is a high risk of CIN in patients with suspected PE despite three different types of prophylaxis being administered, and no statistically significant differences were observed among prophylactic NAC, NaHCO 3 , and NS in prevention of CIN following contrast-enhanced CTPA.

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“…Acetylcysteine has not been shown to prevent AKI associated with cardiac surgery or in patients with sepsis [77, 78]. In the setting of CI-AKI, results have been contradictory, but several meta-analyses suggest that acetylcysteine provides some protection against CI-AKI, especially in patients at high risk [76, 79, 80]. Due to the heterogeneity of study results, it is difficult to establish a clear consensus, but the KDIGO work group has proposed that oral acetylcysteine along with intravenous isotonic crystalloid solutions should be used in patients at high risk of CI-AKI [68].…”

Section: Treatment and Management Of Akimentioning

confidence: 99%

Acute kidney injury—an overview of diagnostic methods and clinical management

Hertzberg¹,

Rydén²,

Pickering³

et al. 2017

Clinical Kidney Journal

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Acute kidney injury (AKI) is a common condition in multiple clinical settings. Patients with AKI are at an increased risk of death, over both the short and long term, and of accelerated renal impairment. As the condition has become more recognized and definitions more unified, there has been a rapid increase in studies examining AKI across many different clinical settings. This review focuses on the classification, diagnostic methods and clinical management that are available, or promising, for patients with AKI. Furthermore, preventive measures with fluids, acetylcysteine, statins and remote ischemic preconditioning, as well as when dialysis should be initiated in AKI patients are discussed. The classification of AKI includes both changes in serum creatinine concentrations and urine output. Currently, no kidney injury biomarkers are included in the classification of AKI, but proposals have been made to include them as independent diagnostic markers. Treatment of AKI is aimed at addressing the underlying causes of AKI, and at limiting damage and preventing progression. The key principles are: to treat the underlying disease, to optimize fluid balance and optimize hemodynamics, to treat electrolyte disturbances, to discontinue or dose-adjust nephrotoxic drugs and to dose-adjust drugs with renal elimination.

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The effectiveness of N-acetylcysteine in preventing contrast-induced nephropathy in patients undergoing contrast-enhanced computed tomography: a meta-analysis of randomized controlled trials

Abstract: This review provides evidence of the efficacy of NAC in preventing the incidence of CIN and recommends that NAC be more widely used in high-risk patients undergoing contrast-enhanced CT. On the basis of the evidence reviewed, further research involving large RCTs may be warranted.

Cited by 44 publications

References 21 publications

Pterostilbene suppressed irradiation-resistant glioma stem cells by modulating GRP78/miR-205 axis

Pterostilbene suppressed irradiation-resistant glioma stem cells by modulating GRP78/miR-205 axis

The High Risk of Contrast‐induced Nephropathy in Patients with Suspected Pulmonary Embolism Despite Three Different Prophylaxis: A Randomized Controlled Trial

Acute kidney injury—an overview of diagnostic methods and clinical management

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