Role of N-acetylcysteine in prevention of contrast-induced nephropathy after cardiovascular procedures: A meta-analysis

Deepika Misra, Keith Leibowtiz, Ramesh M. Gowda, Michael Shapiro, Ijaz A. Khan

    Research output: Contribution to journalArticle

    61 Scopus citations

    Abstract

    Background: Contrast-induced nephropathy is one of the common causes of acute renal insufficiency after cardiovascular procedures. Hypothesis: The objective of this paper was to analyze the published data on the usefulness of N-acetylcysteine in the prevention of contrast-induced nephropathy after these procedures. Methods: Trials were selected if they were prospective, randomized, controlled, had selected patients with impaired renal function, used low-osmolality, nonionic contrast media intra-arterially, administered a total of four doses of N-acetylcysteine in addition to intravenous saline hydration, and had contrast-induced nephropathy as their primary outcome. Contrast-induced nephropathy was defined as an increase in serum creatinine concentration by >0.5 mg/dl or a 25% increase above baseline at or within 48 h post procedure. Meta-analysis was performed using the Fisher's Combined Test with a measure of effect size. The magnitude of the N-acetylcysteine effect was estimated using random-effects models. Homogeneity was evaluated using the chi-square test of homogeneity and standard Q statistic. Reporting bias was explored by the Rosenthal method. Results: The Fisher's Combined Test was significant at p<0.005 in favor of N-acetylcysteine, The size of the N-acetylcysteine effect was to reduce contrast-induced nephropathy by 20%. There was a 62% relative risk reduction in contrast-induced nephropathy with N-acetylcysteine using a fixed-effects model, and a 70% relative risk reduction using the random-effects model, in addition, we found that 27 unpublished trials showing no effects of N-acetylcysteine would exist to overturn the combined significance of p<0.005 of the five trials in our meta-analysis. Conclusion: Oral administration of N-acetylcysteine in addition to intravenous saline hydration has a beneficial effect in the prevention of contrast-induced nephropathy after cardiovascular procedures in patients with impaired renal function.

    Original languageEnglish (US)
    Pages (from-to)607-610
    Number of pages4
    JournalClinical Cardiology
    Volume27
    Issue number11
    DOIs
    StatePublished - Nov 2004

    Keywords

    • Cardiac catheterization
    • Contrast induced nephropathy
    • Coronary angiography
    • N-acetylcysteine
    • Percutanous coronary intervention
    • Radio contrast dyes
    • Renal failure

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

    Fingerprint Dive into the research topics of 'Role of N-acetylcysteine in prevention of contrast-induced nephropathy after cardiovascular procedures: A meta-analysis'. Together they form a unique fingerprint.

  • Cite this