Prevention of radiocontrast nephropathy with N-acetylcysteine in patients with chronic kidney disease: a meta-analysis of randomized, controlled trials

Alonso, Álvaro; Lau, Joseph; Jaber, Bertrand L.; Weintraub, Andrew; Sarnak, Mark J.

doi:10.1053/j.ajkd.2003.09.009

Cited by 277 publications

(126 citation statements)

References 44 publications

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“…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). Most report a risk reduction, although study heterogeneity and positive reporting bias somewhat hinders definitive recommendations [229].…”

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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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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“…RCN is associated with both short-and long-term morbidity and mortality. Estimates of in-hospital mortality rates are as high as 34% in patients who develop acute renal failure compared with 7% in those who do not [77].…”

Section: N-acetyl Cysteine (Nac)mentioning

confidence: 99%

The formulation for cancer prevention & therapy

Thornthwaite¹,

Shah²,

Shah³

et al. 2013

ABC

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“…Isenbarger et al 69 reported a similar result. The meta-analysis by Alonso et al, 70 including 8 prospective, randomized trials published in full-text articles and 4 additional studies published in abstract form, showed that acetylcysteine significantly reduces the risk for CIN. Bagshaw and Ghali 71 analyzed 14 angiography trials including 1261 patients and reported a relative risk of 0.54 (95% CI, 0.32 to 0.91; Pϭ0.02).…”

Section: Acetylcysteine: Meta-analysesmentioning

confidence: 99%

Contrast-Induced Nephropathy

2006

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ontrast medium-induced nephropathy (CIN) is a common cause of acute renal dysfunction. During the past few years, several publications have provided clinical and experimental data on this topic. Our review focuses on 4 major concerns of CIN relevant in clinical practice: (1) What is the evidence that CIN is a clinically relevant and a dangerous condition for the patient? (2) Is there a difference in CIN rate among different contrast media, and how is that related to the physicochemical properties of different available contrast media? (3) What is the evidence that periprocedural hydration is an effective, appropriate, and safe method to prevent CIN? (4) What is the evidence for the use of a drug, in particular acetylcysteine, to prevent CIN? Clinical RelevanceCIN has gained increased attention in the clinical setting, particularly during cardiac intervention but also in many other radiological procedures in which iodinated contrast media are used. There is at present good clinical evidence from well-controlled randomized studies that CIN is a common cause of acute renal dysfunction. 1,2 CIN is the acute deterioration of renal function after parenteral administration of radiocontrast media in the absence of other causes. CIN is generally defined as an increase in serum creatinine concentration of Ͼ0.5 mg/dL (Ͼ44 mol/L) or 25% above baseline within 48 hours after contrast administration. [3][4][5][6][7] Although the exact mechanisms of CIN have yet to be fully elucidated, several causes have been described. Increased adenosine-, endothelin-, and free radical-induced vasoconstriction and reduced nitric oxide-and prostaglandin-induced vasodilatation have been observed. These mechanisms cause ischemia in the deeper portion of the outer medulla, an area with high oxygen requirements and remote from the vasa recta supplying the renal medulla with blood. Contrast agents also have direct toxic effects on renal tubular cells, causing vacuolization, altered mitochondrial function, and apoptosis. 8 Atopy does not play a role in the pathogenesis of CIN.The incidence of CIN in the general population has been calculated to be Ͻ2%. In high-risk patients, ie, patients with chronic renal impairment, diabetes mellitus, congestive heart failure, and older age, the incidence has been calculated to be Ͼ20% to 30%. 3-7 CIN has been associated with increased morbidity, extended length of hospital stay, and increased costs. 9 Several risk factors have been described for CIN. 10 -12 A risk score for prediction of CIN after percutaneous coronary intervention has been reported by Mehran et al. 12 That risk score includes hypotension (5 points, if systolic blood pressure Ͻ80 mm Hg for at least 1 hour requiring inotropic support), use of intra-aortic balloon pump (5 points), congestive heart failure (5 points, if class III/IV by New York Heart Association classification or history of pulmonary edema), age (4 points, if Ͼ75 years), anemia (3 points, if hematocrit Ͻ39% for men and Ͻ36% for women), diabetes mellitus (3 points), contrast media...

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Prevention of radiocontrast nephropathy with N-acetylcysteine in patients with chronic kidney disease: a meta-analysis of randomized, controlled trials

Cited by 277 publications

References 44 publications

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

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

The formulation for cancer prevention & therapy

Contrast-Induced Nephropathy

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Prevention of radiocontrast nephropathy with N-acetylcysteine in patients with chronic kidney disease: a meta-analysis of randomized, controlled trials

Cited by 277 publications

References 44 publications

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

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

The formulation for cancer prevention &amp; therapy

Contrast-Induced Nephropathy

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Product

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The formulation for cancer prevention & therapy