N-acetylcysteine for the prevention of contrast-induced nephropathy in patients with pre-existing renal insufficiency or diabetes: a systematic review and meta-analysis. (26th November 2015)

• Record Type: Journal Article
• Authors: Kang, Xin; Hu, Da-Yong; Li, Chang-Bin; Ai, Zi-Sheng; Peng, Ai
• Is Part Of: Renal failure. Volume 37:Number 10(2015)
• Page Start: 297
• Page End: 303
• Publication Date: 2015-11-26
• Subjects: Contrast-induced nephropathy -- diabetes -- meta-analysis -- N-acetylcysteine -- renal insufficiency; Chronic renal failure -- Periodicals; Acute renal failure -- Periodicals; Uremia -- Periodicals; 616.614005
• DOI: 10.3109/0886022X.2015.1012985
• Languages: English
• ISSNs: 0886-022X

Abstract

Abstract: Purpose : To identify benefit of N -acetylcysteine (NAC) on patients with pre-existing renal insufficiency or diabetes. Background : NAC administration is a common method for prevention of contrast-induced nephropathy (CIN). Nevertheless, its benefit on patients with pre-existing renal insufficiency or diabetes remains uncertain and controversial. Methods: Randomized controlled trials (RCTs) to evaluate the efficacy of NAC for the prevention of CIN in patients with pre-existing renal insufficiency or diabetes were searched from the databases of MEDLINE, EMBASE, and Cochrane library. Pooled odds ratio (OR) with 95% confidence interval (95% CI) were calculated using fixed-effects model by the Mantel–Haenszel test. Results : Twenty RCTs involving 3466 subjects (1756 assigned to NAC and 1710 assigned to the control) were included in the pre-existing renal dysfunction group. Pooled analysis suggested a significant reduction in CIN among this group (OR, 0.76; 95% CI, 0.61–0.93; p = 0.008). However, the nine trials comparing NAC versus control among patients with diabetes (NAC, 367 subjects; control, 358 subjects) showed no benefit of NAC for prevention of CIN (OR = 0.87; 95% CI, 0.58–1.30; p = 0.50). No significant heterogeneity was detected ( p = 0.07; I 2 = 34% for the group of pre-existing renal dysfunction; p = 0.40; I 2 = 5% for the group of diabetes). Conclusion : Our results suggest that NAC decreases the incidence of contrast-induced nephropathy among patients with pre-existing renal insufficiency. The benefit was not existed in patients with diabetes.