CLINICAL NEPHROLOGY - EPIDEMIOLOGY - CLINICAL TRIALS Systematic review of the impact of N-acetylcysteine on contrast nephropathy

Pannu, Neesh; Manns, Braden; Lee, Helen; Tonelli, Marcello
April 2004
Kidney International;Apr2004, Vol. 65 Issue 4, p1366
Academic Journal
Systematic review of the impact of N-acetylcysteine on contrast nephropathy. Background. The efficacy of N-acetylcysteine (NAC) for preventing contrast nephropathy is uncertain. We performed a systematic review and meta-analysis to assess the efficacy of NAC for preventing contrast nephropathy after administration of intravenous contrast media. Methods. Data were obtained from searching MEDLINE (1969–2003) and EMBASE (1988–2003), Cochrane Controlled Clinical Trial Registry (2002, Volume 3), and conference proceedings. We considered all randomized studies that compared changes in renal function between groups that received and did not receive NAC. Studies in which the control group also received active therapy were excluded, although cointervention directed at both groups was permitted. Two reviewers independently extracted quantitative and qualitative data. Disagreements were resolved by consensus with the aid of a third party. Results. Fifteen studies with a total of 1776 patients satisfied inclusion and exclusion criteria. Contrast nephropathy was typically defined by an increase in serum creatinine of 0.5 mg/dL within 24 to 48 hours of contrast administration. The pooled random effect relative risk was 0.65 (0.43–1.00, P= 0.049), indicating that NAC significantly reduced the incidence of contrast nephropathy. However, the effect of NAC was not statistically significant in several prespecified subgroup analyses, and the results were not robust to the addition of hypothetical new or unidentified randomized trials. There was evidence of significant heterogeneity in NAC effect across studies (Q = 26.3, P= 0.02). Random effects meta-regression did not implicate identified differences in participant or study characteristics as responsible for the observed heterogeneity. Conclusion. NAC may reduce the incidence of acutely increased serum creatinine after administration of intravenous contrast, but this finding was of borderline statistical significance, and there was significant heterogeneity between trials. Before NAC becomes the standard of care for all patients receiving intravenous contrast, new randomized trials evaluating its effect on clinically relevant outcomes are required.


Related Articles

  • A linear relationship between serum high-sensitive C-reactive protein and hemoglobin in hemodialysis patients. Heidari, Behzad; Fazli, Muhammad; Misaeid, Muhammad; Heidari, Parham; Hakimi, Niloofar; Zeraati, Abbas // Clinical & Experimental Nephrology;Aug2015, Vol. 19 Issue 4, p725 

    Background: Inflammatory process in hemodialysis patients involves hematopoiesis. The aim of the study was to determine the relationship between serum C-reactive protein (CRP) as a marker of inflammation with hemoglobin in patients under hemodialysis. Methods: Patients under maintenance...

  • Bilateral quadriceps tendon rupture in a hemodialysis patient. Artan, Ayse; Basgoze, Barbaros // Clinical & Experimental Nephrology;Aug2015, Vol. 19 Issue 4, p755 

    No abstract available.

  • FSGS-CT: A multicenter collaborative study.  // Pediatric Nephrology;May2006, Vol. 21 Issue 5, p749 

    The article discusses the FSGS, a phase III multicenter, collaborative, randomized trial of patients with end-stage renal disease. The two study medications used are cyclosporine or pulse dexamethasone and mycophenolate mofetil. The primary outcome of the study is remission of proteinuria. It...

  • Red cell distribution width is an independent factor for left ventricular diastolic dysfunction in patients with chronic kidney disease. Gromadziński, Leszek; Januszko-Giergielewicz, Beata; Pruszczyk, Piotr // Clinical & Experimental Nephrology;Aug2015, Vol. 19 Issue 4, p616 

    Background: The increased value of the red cell distribution width (RDW) was reported to indicate poor prognosis in patients with chronic heart failure. We evaluated the value of the RDW in the diagnosis of left ventricular diastolic dysfunction (LVDD) in patients without diastolic heart failure...

  • Apoptosis induced by an uromodulin mutant C112Y and its suppression by topiroxostat. Utami, Sulistiyati; Mahati, Endang; Li, Peili; Maharani, Nani; Ikeda, Nobuhito; Bahrudin, Udin; Munemura, Chishio; Hosoyamada, Makoto; Yamamoto, Yasutaka; Yoshida, Akio; Nakayama, Yuji; Higaki, Katsumi; Nanba, Eiji; Ninomiya, Haruaki; Shirayoshi, Yasuaki; Ichida, Kimiyoshi; Yamamoto, Kazuhiro; Hosoya, Tatsuo; Hisatome, Ichiro // Clinical & Experimental Nephrology;Aug2015, Vol. 19 Issue 4, p576 

    Background: Familial juvenile hyperuricemic nephropathy (FJHN) is an autosomal dominant disorder caused by mutations in UMOD that encodes uromodulin. Topiroxostat, a novel non-purine analog, selectively inhibits xanthine oxidase and reduces the serum uric acid levels and the urinary albuminuria....

  • Deficiency of endothelial nitric oxide signaling pathway exacerbates peritoneal fibrosis in mice. Kadoya, Hiroyuki; Satoh, Minoru; Nagasu, Hajime; Sasaki, Tamaki; Kashihara, Naoki // Clinical & Experimental Nephrology;Aug2015, Vol. 19 Issue 4, p567 

    Background: Long-term peritoneal dialysis (PD) causes peritoneal dysfunction and structural alterations, eventually leading to peritoneal fibrosis. The endothelial nitric oxide synthase (eNOS)-NO signaling pathway contributes to the progression of organ fibrosis. However, it remains unknown...

  • Dietary phosphorus intake and distribution in Chinese peritoneal dialysis patients with and without hyperphosphatemia. Jiang, Na; Fang, Wei; Yang, Xiaoxiao; Zhang, Lin; Yuan, Jiangzi; Lin, Aiwu; Ni, Zhaohui; Qian, Jiaqi // Clinical & Experimental Nephrology;Aug2015, Vol. 19 Issue 4, p694 

    Background: The present study was conducted to analyze the dietary phosphorus intake and distribution in different food categories in peritoneal dialysis (PD) patients, to evaluate the relationship between dietary phosphorus intake and hyperphosphatemia. Methods: It was a cross-sectional study,...

  • Responsiveness to erythropoiesis-stimulating agents and renal survival in patients with chronic kidney disease. Kuwahara, Michio; Mandai, Shintaro; Kasagi, Yuri; Kusaka, Keita; Tanaka, Tomomi; Shikuma, Satomi; Akita, Wataru // Clinical & Experimental Nephrology;Aug2015, Vol. 19 Issue 4, p598 

    Background: Renal anemia of chronic kidney disease (CKD) is generally treated by erythropoiesis-stimulating agents (ESAs). However, there are individual differences in patients' responsiveness to ESA, which may affect the prognosis of CKD. Methods: The effect of ESAs on hemoglobin was followed...

  • Prevalence of anti-phospholipase A2 receptor antibodies in Japanese patients with membranous nephropathy. Akiyama, Shin'ichi; Akiyama, Mari; Imai, Enyu; Ozaki, Takenori; Matsuo, Seiichi; Maruyama, Shoichi // Clinical & Experimental Nephrology;Aug2015, Vol. 19 Issue 4, p653 

    Background: Membranous nephropathy (MN) is the leading cause of nephrotic syndrome in adults. Anti-M-type phospholipase A2 receptor (anti-PLA2R) antibodies are found in most patients with idiopathic MN (iMN) worldwide, but the prevalence of anti-PLA2R antibodies among Japanese patients with MN...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics