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 In addition, we found that 27 unpublished trials showing no effects of N-acetylcysteine would exist to overturn the combined significance of p 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.
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http://dx.doi.org/10.1002/clc.4960271106 | DOI Listing |
Narra J
December 2024
Department of Urology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Contrast-induced acute kidney injury is a common complication marked by reduced kidney function within 48 hours of contrast administration. The aim of this study was to evaluate renal function, anatomy, and molecular changes at 24 hours, 48 hours, and 72 hours post-iodinated contrast media (ICM) administration. This true-experimental study used a post-test-only control group design.
View Article and Find Full Text PDFBMC Emerg Med
January 2025
Department of Emergency Medicine, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, 53020, Turkey.
Background: The incidence of contrast-induced acute kidney injury (CI-AKI) in the general population ranges from 0.6 to 2.3%, whereas for specific high-risk patients, the incidence can reach more than 30-40%.
View Article and Find Full Text PDFActa Cardiol Sin
January 2025
Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey.
Aims: Contrast-induced nephropathy (CIN) is a condition characterized by rapidly decreasing renal funciton following by the application of contrast material. Precutaneous coronary intervention (PCI) is a life-saving treatment method that should be applied under emergent conditions. Unfortunately, the incidence of CIN after PCI is common.
View Article and Find Full Text PDFProg Cardiovasc Dis
January 2025
Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA; New York Institute of Technology, Old Westbury, New York, USA. Electronic address:
Coronary artery disease (CAD) is the leading cause of mortality among patients with chronic kidney disease (CKD), presenting unique challenges in diagnosis and management. Advanced CKD patients often present with atypical symptoms, and conventional diagnostic and interventional approaches carry risks, including contrast-induced nephropathy and the potential need for renal replacement therapy. These risks have led to the phenomenon of "renalism," where necessary procedures may be deferred due to concerns over renal injury.
View Article and Find Full Text PDFGlob Heart
January 2025
Adult Cardiology Department, Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt.
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