N-acetylcysteine reduces contrast-associated nephropathy but not clinical events during long-term follow-up

Miner, Steven E.S.; Džavík, Vladimir; Nguyen-Ho, Phong; Richardson, Robert; Mitchell, Jan; Atchison, Deborah J.; Seidelin, Peter H.; Daly, Paul; Ross, John; McLaughlin, Peter R.; Ing, Douglas; Lewycky, Peter; Barolet, Alan; Schwartz, Leonard

doi:10.1016/j.ahj.2004.05.015

Cited by 101 publications

(66 citation statements)

References 25 publications

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“…30 Our study simultaneously compared multiple 35 36 treatment strategies using Bayesian network meta-analysis method, and found that 37 38 39 patients using CM were most likely to benefit from high-dose statin. The results of the 40 41 42 current study were similar to findings from previous primary studies [31][32][33][34] and meta- 43 44 45 analyses, 6,[35][36][37] which suggested that short-term prophylaxis with high-dose statins led 46 47 to a significant reduction in the risk of CI-AKI. In contrast, the meta-analysis by 1 Pre-existing renal dysfunction is an independent predictor of CI-AKI.…”

supporting

confidence: 80%

Comparative Effectiveness of 12 Treatment Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-analysis

Xie

Liu

et al. 2017

American Journal of Kidney Diseases

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supporting

confidence: 80%

Comparative Effectiveness of 12 Treatment Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-analysis

Xie

Liu

et al. 2017

American Journal of Kidney Diseases

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“…An issue of concern is also the fact that the endpoint used in all the studies is a change in creatinine and not clinically relevant endpoints such as a need for RRT, length of stay or death. This is corroborated by a recent study where contrast-induced AKI was not independently associated with death and had no effect on other clinical events [6,219]. In patients stratified as high or low risk based on GFR, NAC conferred some benefit when combined with hydration, with multivariate analysis confirming age, volume of contrast, diabetes, and peripheral vascular disease as significant factors for CIN development [232].…”

Section: Rationalesupporting

confidence: 69%

“…There is no evidence that administration of NAC increases glutathione concentrations in the kidney [211,212]. NAC has mainly been studied in the setting of contrast nephropathy following the initial publication by Tepel et al [213] which provided the catalyst for the subsequent proliferation of similar studies [127, [213][214][215][216][217][218][219][220][221][222]. This subject continues to generate much research and has led to several meta-analysis [152, [223][224][225][226][227][228] (ESM Table S9).…”

Section: Rationalementioning

confidence: 99%

Prevention of acute kidney injury and protection of renal function in the intensive care unit

et al. 2009

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Background: Acute renal failure on the intensive care unit is associated with significant mortality and morbidity. Objectives: To determine recommendations for the prevention of acute kidney injury (AKI), focusing on the role of potential preventative maneuvers including volume expansion, diuretics, use of inotropes, vasopressors/vasodilators, hormonal interventions, nutrition, and extracorporeal techniques. Method: A systematic search of the literature was performed for studies using these potential protective agents in adult patients at risk for acute renal failure/kidney injury between 1966 and 2009. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, and use of potentially nephrotoxic drugs and radiocontrast media. Where possible the following endpoints were extracted: creatinine clearance, glomerular filtration rate, increase in serum creatinine, urine output, and markers of tubular injury. Clinical endpoints included the need for renal replacement therapy, length of stay, and mortality. Studies are graded according to the international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) group system Conclusions and recommendations: Several measures are recommended, though none carries grade 1A. We recommend prompt resuscitation of the circulation with special attention to providing adequate hydration whilst avoiding high-molecular-weight hydroxy-ethyl starch (HES) preparations, maintaining adequate blood Intensive Care Med (2010) 36:392-411 DOI 10.1007/s00134-009-1678 EXPERT PANEL pressure using vasopressors in vasodilatory shock. We suggest using vasopressors in vasodilatory hypotension, specific vasodilators under strict hemodynamic control, sodium bicarbonate for emergency procedures administering contrast media, and periprocedural hemofiltration in severe chronic renal insufficiency undergoing coronary intervention.

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“…In contrast to these studies, Miner et al performed a randomized trial of high-dose NAC versus placebo in 180 patients undergoing PCI or coronary angiography with a high likelihood of PCI (16). CIN occurred in 9.6% of NAC-treated patients and 22.2% of patients assigned to placebo (P ϭ 0.04).…”

Section: Randomized Clinical Trialsmentioning

confidence: 99%

Contrast-Induced Nephropathy

Rudnick¹,

Feldman²

2008

Clinical Journal of the American Society of Nephrology

145

120

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Background and objectives:Observational studies have demonstrated that short-and long-term mortality is increased in patients who develop contrast-induced nephropathy (CIN). The more clinically relevant questions, and the objectives of this review, are whether CIN is causally related to mortality, and to what extent could mortality in patients undergoing contrast procedures be reduced by preventing CIN.Design, setting, participants, & measurements: A literature review was conducted, focusing on observational studies that assessed factors associated with mortality in patients with CIN.Results: The deaths of some patients with CIN are complicated by factors that cannot be directly related to CIN, such as liver disease, sepsis, respiratory failure, bleeding, etc. However, it is plausible that CIN contributes to cardiovascular causes of death in patients with CIN.Conclusions: At the very least, CIN is a marker for increased mortality. More carefully designed prospective studies are needed to fully elucidate the relationship between CIN and death. In the absence of data disproving a causal relationship between CIN and death in all subgroups, reducing its incidence should remain a goal in clinical practice as well as a target for future research.

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N-acetylcysteine reduces contrast-associated nephropathy but not clinical events during long-term follow-up

Cited by 101 publications

References 25 publications

Comparative Effectiveness of 12 Treatment Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-analysis

Comparative Effectiveness of 12 Treatment Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-analysis

Prevention of acute kidney injury and protection of renal function in the intensive care unit

Contrast-Induced Nephropathy

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