PURPOSE: Contrast-induced nephropathy is an important cause of acute renal failure. We assess the efficacy of acetylcysteine for prevention of contrast-induced nephropathy among patients undergoing intravascular angiography.

METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials comparing prophylactic acetylcysteine plus hydration versus hydration alone in patients undergoing intravascular angiography. Studies were identified by search of MEDLINE, EMBASE, Cochrane Controlled Clinical Trials Register and conference proceedings. Our main outcome measures were the risk of contrast-induced nephropathy and the difference in serum creatinine between acetylcysteine and control groups at 48 hours.

RESULTS: Ten peer-reviewed randomized controlled trials involving 1041 patients were identified and included for analysis. Acetylcysteine was associated with a significantly reduced incidence of contrast-induced nephropathy in 5 studies, and no difference in the other 5 (with a trend toward a higher incidence in four of the latter studies). The pooled odds ratio for contrast-induced nephropathy with acetylcysteine relative to control was 0.45 (95% CI, 0.24-0.86, p=0.016) and the pooled estimate of difference in 48-hour serum creatinine for acetylcysteine relative to control was –12.7 µmol/L (95% CI –25.8 to 0.50, p=0.059). These pooled values need to be interpreted cautiously because of the significant heterogeneity across studies, and due to evidence of publication bias. Meta-regression suggested that the heterogeneity might be partially explained by whether the angiography was performed electively or emergently. However, no differences were identified for baseline serum creatinine levels, volume of contrast media, volume of hydration, age, diabetes mellitus, and a number of trial methodology factors.

CONCLUSION: These findings indicate that published studies of acetylcysteine for prevention of contrast-induced nephropathy yield inconsistent results. The efficacy of acetylcysteine will remain uncertain unless a large well-designed multi-center trial is performed that incorporates evaluation of clinically meaningful outcomes.

DNC

NEXT