High-dose N-acetylcysteine for the Prevention of Contrast-induced Nephropathy

Hariprasad Trivedi, Sumanth Daram, Aniko Szabo, Antonio L. Bartorelli, Giancarlo Marenzi

Research output: Contribution to journalArticle

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Abstract

Background: Whether N-acetylcysteine is beneficial for the prevention of contrast-induced nephropathy is uncertain. Methods: We conducted a meta-analysis to evaluate the efficacy of high-dose N-acetylcysteine for the prevention of contrast-induced nephropathy. Our prespecified inclusion criteria were as follows: adult subjects; English language literature; administration of high-dose N-acetylcysteine a priori defined as a daily dose greater than 1200 mg or a single periprocedural dose (within 4 hours of contrast exposure) greater than 600 mg; prospective trials of individuals randomized to N-acetylcysteine, administered orally or intravenously, versus a control group; and trials that included the end point of the incidence of contrast-induced nephropathy. Trials that compared N-acetylcysteine with another active treatment were excluded. Results: Sixteen comparisons of patients randomized to high-dose N-acetylcysteine versus controls met our prespecified inclusion criteria with a total sample size of 1677 subjects (842 assigned to high-dose N-acetylcysteine and 835 assigned to the control arm). The average population age was 68 years, 38.7% were diabetic, and the majority was male (67.8% of reported instances). The weighted mean baseline creatinine of the overall population was 1.58 mg/dL. No significant heterogeneity was detected (P = .09; I2 = 34%). The overall effect size assuming a common odds ratio revealed an odds ratio of 0.46 (95% confidence interval [CI], 0.33-0.63) for the occurrence of contrast-induced nephropathy with the use of high-dose N-acetylcysteine. The results of the more conservative random effects approach were similar (odds ratio = 0.52; 95% CI, 0.34-0.78). There was no evidence of publication bias (P = .34). Conclusion: Our results suggest that high-dose N-acetylcysteine decreases the incidence of contrast-induced nephropathy.

Original languageEnglish (US)
Pages (from-to)874.e9-874.e15
JournalAmerican Journal of Medicine
Volume122
Issue number9
DOIs
StatePublished - Sep 1 2009

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Acetylcysteine
Odds Ratio
Confidence Intervals
Publication Bias
Incidence
Sample Size
Population
Meta-Analysis
Creatinine
Language
Control Groups

Keywords

  • Acute
  • Contrast-induced nephropathy
  • N-acetylcysteine
  • Radiocontrast media
  • Renal failure

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Trivedi, H., Daram, S., Szabo, A., Bartorelli, A. L., & Marenzi, G. (2009). High-dose N-acetylcysteine for the Prevention of Contrast-induced Nephropathy. American Journal of Medicine, 122(9), 874.e9-874.e15. https://doi.org/10.1016/j.amjmed.2009.01.035

High-dose N-acetylcysteine for the Prevention of Contrast-induced Nephropathy. / Trivedi, Hariprasad; Daram, Sumanth; Szabo, Aniko; Bartorelli, Antonio L.; Marenzi, Giancarlo.

In: American Journal of Medicine, Vol. 122, No. 9, 01.09.2009, p. 874.e9-874.e15.

Research output: Contribution to journalArticle

Trivedi, H, Daram, S, Szabo, A, Bartorelli, AL & Marenzi, G 2009, 'High-dose N-acetylcysteine for the Prevention of Contrast-induced Nephropathy', American Journal of Medicine, vol. 122, no. 9, pp. 874.e9-874.e15. https://doi.org/10.1016/j.amjmed.2009.01.035
Trivedi, Hariprasad ; Daram, Sumanth ; Szabo, Aniko ; Bartorelli, Antonio L. ; Marenzi, Giancarlo. / High-dose N-acetylcysteine for the Prevention of Contrast-induced Nephropathy. In: American Journal of Medicine. 2009 ; Vol. 122, No. 9. pp. 874.e9-874.e15.
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abstract = "Background: Whether N-acetylcysteine is beneficial for the prevention of contrast-induced nephropathy is uncertain. Methods: We conducted a meta-analysis to evaluate the efficacy of high-dose N-acetylcysteine for the prevention of contrast-induced nephropathy. Our prespecified inclusion criteria were as follows: adult subjects; English language literature; administration of high-dose N-acetylcysteine a priori defined as a daily dose greater than 1200 mg or a single periprocedural dose (within 4 hours of contrast exposure) greater than 600 mg; prospective trials of individuals randomized to N-acetylcysteine, administered orally or intravenously, versus a control group; and trials that included the end point of the incidence of contrast-induced nephropathy. Trials that compared N-acetylcysteine with another active treatment were excluded. Results: Sixteen comparisons of patients randomized to high-dose N-acetylcysteine versus controls met our prespecified inclusion criteria with a total sample size of 1677 subjects (842 assigned to high-dose N-acetylcysteine and 835 assigned to the control arm). The average population age was 68 years, 38.7{\%} were diabetic, and the majority was male (67.8{\%} of reported instances). The weighted mean baseline creatinine of the overall population was 1.58 mg/dL. No significant heterogeneity was detected (P = .09; I2 = 34{\%}). The overall effect size assuming a common odds ratio revealed an odds ratio of 0.46 (95{\%} confidence interval [CI], 0.33-0.63) for the occurrence of contrast-induced nephropathy with the use of high-dose N-acetylcysteine. The results of the more conservative random effects approach were similar (odds ratio = 0.52; 95{\%} CI, 0.34-0.78). There was no evidence of publication bias (P = .34). Conclusion: Our results suggest that high-dose N-acetylcysteine decreases the incidence of contrast-induced nephropathy.",
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