Meta-analytic Techniques to Assess the Association Between N-acetylcysteine and Acute Kidney Injury After Contrast Administration

K, Magner; Ilin, Julius Vladimir; Clark, Edward G.; Kong, Jennifer; Davis, Alexandra; Hiremath, Swapnil

doi:10.1001/jamanetworkopen.2022.20671

Cited by 17 publications

(12 citation statements)

References 38 publications

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“…NAC positive on humans [53][54][55][56][57][58]60], meta-analyses [59,61,71] no results on humans [62][63][64][65][66][67], meta-analyses [68,69,72] Glutathione no results on humans [78][79][80] Vitamin C positive on humans [96][97][98], meta-analyses [94,95] no results on humans [99][100][101][102][103][104] Vitamin E positive on humans, meta-analyses [113,114] no results on humans [115,116] Bilirubin/HO-1 positive (expected)…”

Section: Results Of Using Against Cin Clinical Trials (Studies)mentioning

confidence: 99%

Endogenous and Exogenous Antioxidants as Agents Preventing the Negative Effects of Contrast Media (Contrast-Induced Nephropathy)

Панова¹,

Татиколов

2023

Pharmaceuticals

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The use of conventional contrast media for diagnostic purposes (in particular, Gd-containing and iodinated agents) causes a large number of complications, the most common of which is contrast-induced nephropathy. It has been shown that after exposure to contrast agents, oxidative stress often occurs in patients, especially in people suffering from various diseases. Antioxidants in the human body can diminish the pathological consequences of the use of contrast media by suppressing oxidative stress. This review considers the research studies on the role of antioxidants in preventing the negative consequences of the use of contrast agents in diagnostics (mainly contrast-induced nephropathy) and the clinical trials of different antioxidant drugs against contrast-induced nephropathy. Composite antioxidant/contrast systems as theranostic agents are also considered.

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Section: Results Of Using Against Cin Clinical Trials (Studies)mentioning

confidence: 99%

Endogenous and Exogenous Antioxidants as Agents Preventing the Negative Effects of Contrast Media (Contrast-Induced Nephropathy)

Панова¹,

Татиколов

2023

Pharmaceuticals

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“…Of these, 46 articles were considered for full-text review. Ultimately, 12 meta-analyses (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) were included in our overall meta-analysis. A summary of the excluded papers after following the selection criteria for overlapping meta-analyses is provided in Supplementary Table S2.…”

Section: Study Selection and Study Characteristicsmentioning

confidence: 99%

“…A total of 38,053 individuals from 161 RCTs were included in 12 meta-analyses (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) that explored the influence of NAC on CIN overall. Our pooled effect size showed a significant effect (OR 0.72, 95% CI 0.65 to 0.79, p < 0.00001) (Figure 2).…”

Section: Effect Of Nac On Cinmentioning

confidence: 99%

Association of N-acetylcysteine use with contrast-induced nephropathy: an umbrella review of meta-analyses of randomized clinical trials

Zhu,

Zheng,

Deng

et al. 2023

Front. Med.

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BackgroundThe effectiveness of N-acetylcysteine (NAC) in treating contrast-induced nephropathy (CIN) has been the subject of conflicting meta-analyses, but the strength of the evidence for these correlations between NAC use and CIN has not been measured overall.ObjectiveTo evaluate the data from randomized clinical studies (RCTs) that examined the relationships between NAC use and CIN in meta-analyses.MethodsBetween the creation of the database and April 2023, searches were made in PubMed, Cochrane Library, EMBASE, and Web of Science. N-acetylcysteine, contrast-induced nephropathy, or contrast-induced renal disease were among the search keywords used, along with terms including systematic review and meta-analysis. The Assessment of Multiple Systematic Reviews, version 2, which assigned grades of extremely low, low, moderate, or high quality to each meta-analysis’s scientific quality, was used to evaluate each meta-analysis. The confidence of the evidence in meta-analyses of RCTs was evaluated using the Grading of Recommendation, Assessment, Development and Evaluations method, with evidence being rated as very low, low, moderate, or high.ResultsIn total, 493 records were screened; of those, 46 full-text articles were assessed for eligibility, and 12 articles were selected for evidence synthesis as a result of the screening process. Based on the pooled data, which was graded as moderate-quality evidence, it can be concluded that NAC can decrease CIN (OR 0.72, 95% CI 0.65–0.79, p < 0.00001) and blood levels of serum creatinine (MD −0.09, 95% CI −0.17 to −0.01, p = 0.03). In spite of this, there were no associations between NAC and dialysis requirement or mortality in these studies.ConclusionThe results of this umbrella review supported that the renal results were enhanced by NAC. The association was supported by moderate-quality evidence.Systematic review registration[https://clinicaltrials.gov/], identifier [CRD42022367811].

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“…Numerosos estudios han sido conducidos con el objetivo de evaluar la eficacia de este fármaco, mostrando resultados prometedores inicialmente, los cuales fueron diluyéndose a través del tiempo cuando se realizaban estudios con un diseño metodológico más riguroso y un mayor número de participantes. De hecho, los ensayos grandes (N > 500) han sido más homogéneos y no muestran un beneficio de la NAC en la prevención de la IRA-ACI [101].…”

Section: N-acetilcisteína (Nac)unclassified

“…Magner et al elaboraron un metaanálisis de 101 ensayos clínicos aleatorizados, evidenciando que la NAC se asoció con la prevención de la IRA-ACI cuando todos los estudios se consideraron juntos, utilizando un modelo de regresión de efectos fijos o un análisis de efectos aleatorios; sin embargo, existió una heterogeneidad estadística sustancial y un sesgo de publicación, lo que socavó la validez de estas estimaciones agrupadas. Cuando se restringió el análisis a ensayos con un mayor tamaño muestral (es decir, ensayos con un tamaño de muestra superior a 500 o tasas de eventos superiores a 100), o analizaron los ensayos con resultados clínicos no bioquímicos, se redujeron estos problemas y se alcanzó un efecto nulo en la prevención de la IRA-ACI [101].…”

Section: N-acetilcisteína (Nac)unclassified

Consenso de la Asociación Colombiana de Nefrología e Hipertensión Arterial (Asocolnef) y la Asociación Colombiana de Radiología (ACR) sobre recomendaciones basadas en la evidencia de la injuria renal aguda asociada al uso de medios de contraste yodados (IRA-ACI)

Caicedo¹,

Vásquez²,

Valencia³

et al. 2023

Rev. Colomb. Nefrol.

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Contexto: la injuria renal aguda asociada al uso de medios de contraste yodados (IRA-ACI) es un desorden iatrogénico con potenciales implicaciones en morbilidad y mortalidad, motivo de preocupación en los servicios de imágenes médicas. Los últimos años han marcado cambios importantes en la concepción que poseemos sobre esta entidad desde una definición más precisa, verdadera incidencia, factores de riesgo y escalas predictivas, hasta el impacto real de algunas estrategias para su prevención. Objetivo: generar recomendaciones basadas en la evidencia para el uso de medios de contraste yodados en pacientes sometidos a procedimientos radiológicos diagnósticos o terapéuticos, mediante de un consenso de expertos. Metodología: a partir de la formulación de preguntas de investigación relacionadas con la injuria renal aguda asociada al uso medios de contraste yodados, se realiza la búsqueda de evidencia en Pubmed, Embase y Scopus entre enero del 2013 y agosto del 2022. Los artículos se seleccionaron por medio de una revisión sistemática y a través de la metodología de consenso Delphi modificado. Los documentos fueron analizados usando instrumentos que evalúan la calidad de su evidencia. Resultados: se formularon 22 recomendaciones para el manejo de pacientes que requieren la administración de medios de contraste yodados. Un panel de 11 expertos, entre los que se contó con 4 nefrólogos, 4 radiólogos, 1 nefrólogo pediatra y 2 epidemiólogos, participaron de forma activa en la elaboración del consenso, con un total de cinco sesiones virtuales y 15 horas de trabajo. Conclusiones: el término injuria renal aguda asociada al uso de medios de contraste yodados (IRA-ACI) debe usarse idealmente y abandonar otras definiciones que infieren una causalidad manifiesta; con relación a su incidencia, los datos recientes demuestran que ha sido sobreestimada en la literatura y percibida de forma exagerada por el personal del área de la salud, de igual forma, solo una baja tasa de filtración glomerular estimada (TFGe) se considera como un factor de riesgo independiente para el desarrollo de IRA-ACI. Finalmente, respecto a su prevención, únicamente la hidratación ha mostrado un potencial beneficio como medida nefroprotectora.

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Meta-analytic Techniques to Assess the Association Between N-acetylcysteine and Acute Kidney Injury After Contrast Administration

Cited by 17 publications

References 38 publications

Endogenous and Exogenous Antioxidants as Agents Preventing the Negative Effects of Contrast Media (Contrast-Induced Nephropathy)

Endogenous and Exogenous Antioxidants as Agents Preventing the Negative Effects of Contrast Media (Contrast-Induced Nephropathy)

Association of N-acetylcysteine use with contrast-induced nephropathy: an umbrella review of meta-analyses of randomized clinical trials

Consenso de la Asociación Colombiana de Nefrología e Hipertensión Arterial (Asocolnef) y la Asociación Colombiana de Radiología (ACR) sobre recomendaciones basadas en la evidencia de la injuria renal aguda asociada al uso de medios de contraste yodados (IRA-ACI)

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