Intravenous N-acetylcysteine for preventing contrast-induced nephropathy: A randomised trial

Carbonell, Nieves; Blasco, María Luisa; Sanjuán, Rafael; Pérez-Sancho, Esther; Sanchís, Juan; Insa, Luis; Bodı́, Vicente; Núñez, Julio; García-Ramón, R; Miguel, Alfonso

doi:10.1016/j.ijcard.2006.04.023

Cited by 58 publications

(43 citation statements)

References 38 publications

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“…25 Considering all the studies, neither oral nor intravenous NAC should be routinely prescribed for CIN prophylaxis. 26,27 As reported in many studies, we also found that NAC did not confer any benefit over saline alone.…”

Section: Discussionsupporting

confidence: 81%

Does Nebivolol Prevent Contrast‐Induced Nephropathy in Humans?

Günebakmaz

Kaya

Koç

et al. 2012

Clinical Cardiology

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Background:An experimental study showed that nebivolol is an effective agent in contrast‐induced nephropathy (CIN) prophylaxis.Hypothesis:We hypothesized that prophylactic nebivolol use had protective effects on renal function in human beings subjected to iodinated contrast agent since it has vasodilatory effect and antioxidant properties.Methods:The present study enrolled 120 patients scheduled for coronary angiography and ventriculography. All patients were hydrated with intravenous isotonic saline. The patients in group I received 600 mg N‐acetylcysteine every 12 hours for 4 days. The patients in group II received 5 mg nebivolol every 24 hours for 4 days. The patients in group III were only hydrated. The primary endpoint was the occurrence of CIN. The secondary endpoint was the change in serum creatinine (Cr) levels at 2 days and 5 days after the contrast exposure.Results:Nine (22.5%) patients in group I developed CIN, as did 8 patients (20.0%) in group II and 11 patients (27.5%) in group III (P = 0.72). Changes in mean Cr level from baseline to day 2 were not statistically significant in all groups. However, we detected a statistically significant increase in mean Cr levels at day 5 compared with baseline levels in group I and group III (from 1.42 ± 0.13 to 1.52 ± 0.26, p2 = 0.02; and from 1.43 ± 0.14 to 1.55 ± 0.30, p2 = 0.01, respectively). Although an increase was detected in mean Cr level from baseline to the 5‐day Cr level in group II, this did not reach statistical significance (from 1.40 ± 0.12 to 1.48 ± 0.23, P = 0.06).Conclusions:Pretreatment with nebivolol is protective against nephrotoxic effects of contrast media. © 2012 Wiley Periodicals, Inc.The authors have no funding, financial relationships, or conflicts of interest to disclose.

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Section: Discussionsupporting

confidence: 81%

Does Nebivolol Prevent Contrast‐Induced Nephropathy in Humans?

Günebakmaz

Kaya

Koç

et al. 2012

Clinical Cardiology

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“…The relationship between COL toxicity and cumulative dose has been demonstrated in previous reports [15,16]. The cumulative COL dose, as well as the duration of COL use, were all higher in the NAC+COL group, although the differences did not reach statistical significance (p = 0.802, p = 0.447).…”

Section: Discussionsupporting

confidence: 58%

Colistin-induced nephrotoxicity and the role of N-acetylcysteine: a retrospective cohort study

Bozkurt

Sharma

Esen

2017

J Infect Dev Ctries

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Introduction: Colistin is associated with dose-dependent nephrotoxicity. N-acetylcycteine (NAC) may reduce the risk of concomitant acute kidney injury (AKI) due to its antioxidant properties. We report a retrospective cohort study evaluating the role of N-acetylcysteine (NAC) in the development of colistin (COL) associated nephrotoxicity. Methodology: A single centre retrospective cohort study was conducted in a university hospital between January 2014 and June 2015. Nephrotoxicity was defined and staged per the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria. We evaluated the association between NAC use and COL-related nephrotoxicity by comparing the incidence of nephrotoxicity in patients receiving colistin with or without adjunctive NAC. Results: Forty-six patients received intravenous (IV) COL and 46 patients received IV NAC+COL. The cumulative COL doses did not differ between the two groups (p = 0.802). The initial creatinine value doubled in 29 (63%) patients undergoing NAC+COL therapy and in 27 (58.7%) patients in the COL group (p = 0.669). The median doubling time of baseline creatinine was 6 and 7 days in the NAC+COL and COL groups, respectively. The mean hospital stay, potentially nephrotoxic agent use, and mortality rates were statistically higher for the patients receiving NAC+COL (p < 0.005). Conclusions: The present study was not able to reveal any beneficial effect of NAC for patients undergoing COL therapy. The NAC+COL group had a higher baseline risk for development of AKI. However, the incidence of AKI was comparable between the groups. The results of the study would not solely exhibit the protective effect of adjunctive NAC therapy.

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“…The summary OR for CIN associated with the use of NAC was essentially unchanged at 0.78 (95% CI, 0.63-0.96, p ¼ 0.02), and substantial heterogeneity reduced obviously (p ¼ 0.12, I 2 ¼ 29%). And, in the DM group, after excluding the studies of Carbonell et al, 34 Coyle et al 33 or Rashid et al 30 in which patients with diabetes regardless of renal function, the OR remained insignificant of 0.74 (95% CI, 0.47-1.16, p ¼ 0. 19) and heterogeneity reduced obviously (p ¼ 0.54, I…”

Section: Sensitivity Analysesmentioning

confidence: 91%

N-acetylcysteine for the prevention of contrast-induced nephropathy in patients with pre-existing renal insufficiency or diabetes: a systematic review and meta-analysis

Kang

et al. 2015

Renal Failure

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(2015) Nacetylcysteine for the prevention of contrast-induced nephropathy in patients with pre-existing renal insufficiency or diabetes: a systematic review and meta-analysis, Renal Failure, 37:10,[297][298][299][300][301][302][303] 2 ¼ 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.

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Intravenous N-acetylcysteine for preventing contrast-induced nephropathy: A randomised trial

Cited by 58 publications

References 38 publications

Does Nebivolol Prevent Contrast‐Induced Nephropathy in Humans?

Does Nebivolol Prevent Contrast‐Induced Nephropathy in Humans?

Colistin-induced nephrotoxicity and the role of N-acetylcysteine: a retrospective cohort study

N-acetylcysteine for the prevention of contrast-induced nephropathy in patients with pre-existing renal insufficiency or diabetes: a systematic review and meta-analysis

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