Acetylcysteine for prevention of contrast nephropathy: meta-analysis
Rainer Birck1, Stefan Krzossok, Florian Markowetz
1Fifth Department of Medicine, University Hospital Mannheim, Mannheim, Germany. rainer.birck@med5.ma.uni-heidelberg.de
Insights
Acetylcysteine with hydration significantly reduces the risk of contrast nephropathy in patients with chronic renal insufficiency. This safe and inexpensive treatment is effective regardless of contrast volume or baseline kidney function.
Area of Science:
- Nephrology
- Radiology
- Pharmacology
Background:
- Contrast nephropathy increases morbidity and mortality in patients with chronic renal insufficiency.
- Acetylcysteine is a potential safe and inexpensive preventive agent.
- The study assesses acetylcysteine's efficacy in preventing contrast-induced kidney injury.
Purpose of the Study:
- To evaluate the effectiveness of acetylcysteine in preventing contrast nephropathy.
- To compare acetylcysteine plus hydration versus hydration alone.
- To analyze outcomes in patients with chronic renal insufficiency undergoing procedures with radiocontrast media.
Main Methods:
- Meta-analysis of randomized controlled trials.
- Searched multiple databases including MEDLINE and Cochrane Library.
- Outcome measured: incidence of contrast nephropathy within 48 hours post-procedure.
Main Results:
- Seven trials with 805 patients were analyzed.
- Acetylcysteine and hydration significantly reduced contrast nephropathy risk by 56% (p=0.02).
- No significant relationship found between risk reduction and contrast volume or baseline renal insufficiency.
Conclusions:
- Acetylcysteine combined with hydration effectively reduces contrast nephropathy risk.
- The protective effect is consistent across varying contrast media volumes and degrees of renal insufficiency.
- This regimen offers a valuable strategy for kidney protection in at-risk patients.
Background:
Contrast nephropathy is associated with increased in-hospital morbidity and mortality and leads to extension of hospital stay in patients with chronic renal insufficiency. Acetylcysteine seems to be a safe and inexpensive way to reduce contrast nephropathy. We aimed to assess the efficacy of acetylcysteine to prevent contrast nephropathy after administration of radiocontrast media in patients with chronic renal insufficiency.
Methods:
We did a meta-analysis of randomised controlled trials comparing acetylcysteine and hydration with hydration alone for preventing contrast nephropathy in patients with chronic renal insufficiency. The trials were identified through a combined search of the BIOSIS+/RRM, MEDLINE, Web of Science, Current Contents Medizin, and The Cochrane Library Databases. We used incidence of contrast nephropathy 48 h after administration of radiocontrast media as an outcome measure.
Findings:
Seven trials including 805 patients were eligible according to our inclusion criteria and were analysed. Overall incidence of contrast nephropathy varied between 8% and 28%. Since significant heterogeneity was indicated by the Q statistics (p=0.016) we used a random-effects model to combine the data. Compared with periprocedural hydration alone, administration of acetylcysteine and hydration significantly reduced the relative risk of contrast nephropathy by 56% (0.435 [95% CI 0.215-0.879], p=0.02) in patients with chronic renal insufficiency. Meta-regression revealed no significant relation between the relative risk of contrast nephropathy and the volume of radiocontrast media administered or the degree of chronic renal insufficiency before the procedure.
Interpretation:
Compared with periprocedural hydration alone, acetylcysteine with hydration significantly reduces the risk of contrast nephropathy in patients with chronic renal insufficiency. The relative risk of contrast nephropathy was not related to the amount of radiocontrast media given or to the degree of chronic renal insufficiency before the procedure.
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