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High-dose N-acetylcysteine for the prevention of contrast-induced nephropathy

Hariprasad Trivedi1, Sumanth Daram, Aniko Szabo

  • 1Division of Nephrology and Kidney Disease Center, Medical College of Wisconsin, Milwaukee, USA. htrivedi@mcw.edu

The American Journal of Medicine
|August 25, 2009
PubMed

Insights

High-dose N-acetylcysteine significantly reduces the incidence of contrast-induced nephropathy. This meta-analysis of randomized trials confirms its preventative effect, offering a potential strategy to mitigate kidney damage from contrast agents.

Area of Science:

  • Nephrology
  • Pharmacology
  • Radiology

Background:

  • Contrast-induced nephropathy (CIN) is a significant risk following radiographic procedures.
  • The prophylactic efficacy of N-acetylcysteine (NAC) for CIN remains uncertain.
  • High-dose NAC administration requires further evaluation for CIN prevention.

Purpose of the Study:

  • To conduct a meta-analysis evaluating the efficacy of high-dose N-acetylcysteine in preventing contrast-induced nephropathy.
  • To synthesize evidence from prospective, randomized trials comparing high-dose NAC with control groups.

Main Methods:

  • Meta-analysis of 16 prospective randomized trials including 1677 adult subjects.
  • Inclusion criteria specified high-dose N-acetylcysteine (oral or IV) and CIN as an endpoint.
  • Exclusion of trials comparing NAC with other active treatments.

Main Results:

  • High-dose N-acetylcysteine demonstrated a significant reduction in CIN incidence (OR = 0.46; 95% CI, 0.33-0.63).
  • Analysis included 842 subjects in the NAC arm and 835 in the control arm.
  • No significant heterogeneity or publication bias was detected.

Conclusions:

  • High-dose N-acetylcysteine is effective in decreasing the incidence of contrast-induced nephropathy.
  • Findings support the use of high-dose NAC as a preventative measure against CIN.
  • Further research may explore optimal dosing and patient populations.
Abstract

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