Role of N‐acetylcysteine in prevention of contrast‐induced nephropathy after cardiovascular procedures: A meta‐analysis

Misra, Deepika; Leibowitz, Dalia; Gowda, Ramesh M.; Shapiro, Michael D.; Khan, Ijaz A.

doi:10.1002/clc.4960271106

Cited by 66 publications

(28 citation statements)

References 21 publications

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“…For the purpose of the present investigation, however, the creatinine value taken for further study was the value at admission (thus excluding the possible influence of contrastinduced nephropathy 12 ). eGFR mL/min per 1.73 m 2 was calculated according to the abbreviated Modification of Diet in Renal Disease (MDRD) study equation: GFR = 186× (serum creatinine) −1.154 × (age) −0.203 ×0.742 (in women), as described in the corresponding K/DOQI Clinical Practice Guidelines.…”

Section: Glomerular Filtration Rate Calculationmentioning

confidence: 99%

Glomerular Filtration Rate and Coronary Artery Disease Burden in Patients with Acute Coronary Syndrome

Nunes

Faria

Garcia

et al. 2007

Clinical Cardiology

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SummaryBackground: Mild renal dysfunction may be associated with increased cardiovascular morbidity and mortality.Methods: The relation between estimated glomerular filtration rate (eGFR), as calculated from plasma creatinine at admission, and coronary artery disease burden (CADB), was studied in a cohort of 110 patients with acute coronary syndrome and coronary atherosclerosis.Results: A relatively weak but significant negative correlation was found between eGFR and CADB as measured by angiography (coefficient correlation of −0.26, probability value of 0.006); a similar association was seen in multiple regression analysis, taking CADB as dependent variable, and eGFR, age, plasma calcium and plasma phosphorus as independent variables. After dividing the 110 patients into eGFR tertiles (with mean values of 102.9 ± 22.8, n = 37, 75.7 + or − 5.6, n = 36, and 53.1 ± 13.4, n = 37, all in mL/min per 1.73 m 2 ), mean CADB values of the lower and higher eGFR tertiles were found to be significantly different (270.6 ± 176.4 and 192.9 ± 78.5, respectively). Similar mean values for CADB and for eGFR were noted when patients with elevated ST segment/new left bundle branch block and patients with nonelevated ST segment acute coronary syndrome were compared.Conclusions: We conclude that renal function of patients with acute coronary syndromes and coronary

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Section: Glomerular Filtration Rate Calculationmentioning

confidence: 99%

Glomerular Filtration Rate and Coronary Artery Disease Burden in Patients with Acute Coronary Syndrome

Nunes

Faria

Garcia

et al. 2007

Clinical Cardiology

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“…The disparate results of these clinical trials have led to a proliferation of systematic reviews and meta-analyses comparing the overall prophylactic efficacy of NAC. To date, at least nine meta-analysis of NAC have shown beneficial treatment effects in reducing RCIN [113][114][115][116][117][118][119][120][121] . However, six meta-analyses were inconclusive [122][123][124][125][126][127] .…”

Section: Systemic Reviews and Meta-analyses Of The Efficacy Of Nacmentioning

confidence: 99%

Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography

Hung¹,

Lin²,

Hung³

et al. 2012

WJC

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Radiocontrast-induced nephropathy (RCIN) is an acute and severe complication after coronary angiography, particularly for patients with pre-existing chronic kidney disease (CKD). It has been associated with both short-and long-term adverse outcomes, including the need for renal replacement therapy, increased length of hospital stay, major cardiac adverse events, and mortality. RCIN is generally defined as an increase in serum creatinine concentration of 0.5 mg/dL or 25% above baseline within 48 h after contrast administration. There is no effective therapy once injury has occurred, therefore, prevention is the cornerstone for all patients at risk for acute kidney injury (AKI). There is a small but growing body of evidence that prevention of AKI is associated with a reduction in later adverse outcomes. The optimal strategy for preventing RCIN has not yet been established. This review discusses the principal risk factors for RCIN, evaluates and summarizes the evidence for RCIN prophylaxis, and proposes recommendations for preventing RCIN in CKD patients undergoing coronary angiography.

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“…23 Twelve other metaanalyses, which incorporated fewer studies, have been published, [24][25][26][27][28][29][30][31][32][33][34][35] and 7 of the 12 reported a benefit from NAC. 25,27,29,30,32,34,35 Although meta-analysis is considered the most accepted strategy to define conclusions from multiple trials, conflicting results between NAC meta-analyses highlight the possibility that this approach may still not provide resolution to clinical questions, especially when inclusion criteria differ between meta-analyses. Therefore, as discussed by Bagshaw et al, 36 meta-analyses are not always a panacea, and should be avoided if the trials to be included exhibit significant statistical or clinical heterogeneity, as is the case with studies involving NAC prophylaxis of CN.…”

Section: Oral N-acetylcysteinementioning

confidence: 99%

Evidence‐based approach for prevention of radiocontrast‐induced nephropathy

Jawdeh

Kanso

Schelling

2009

Journal of Hospital Medicine

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Disclosure: Nothing to report.The frequency of radiocontrast administration is dramatically increasing, with over 80 million doses delivered annually worldwide. Although recently developed radiocontrast agents are relatively safe in most patients, contrast nephropathy (CN) is still a major source of in-hospital and long-term morbidity and mortality, particularly in patients with preexisting kidney disease. Multiple protocols for CN prevention have been studied; however, strict guidelines have not been established, in part because of conflicting efficacy data for most prevention approaches. In this work, we critically review the major trials that have addressed common CN prophylaxis strategies, including type of radiocontrast media, N-acetylcysteine administration, extracellular fluid volume expansion, and hemofiltration/hemodialysis. We conclude with evidence-based recommendations for CN prevention, which emphasize concurrent NaHCO 3 infusion and N-acetylcysteine administration. These guidelines should be helpful to hospitalists, who frequently order radiocontrast studies, and could therefore have a significant impact on prevention of CN. KEYWORDS: acute kidney injury, N-acetylcysteine, NaHCO 3 , nephrotoxicity, radioiodinated contrast.Since contrast nephropathy (CN) was recognized more than 50 years ago, 1 there have been continuous efforts to chemically modify radiocontrast agents to be less nephrotoxic. Although radiocontrast media have indeed become safer, which reduces the likelihood of CN per procedure, the indications for radiocontrast administration have dramatically increased, since over 80 million doses are delivered in the world annually. 2,3 Furthermore, the number of patients with CN risks, which are mainly chronic renal insufficiency (CRI) and diabetes (Table 1), has also grown. Currently, more than 26 million people are estimated to have CRI in the United States 4 and 200 million people have diabetes worldwide. 5The combination of increased radiocontrast administration frequency and greater prevalence of at-risk patients is likely to result in continued increases in CN events. The incidence of CN varies between studies, depending on risk factors of the cohort and definition of CN, but figures have been reported to be as high as 50% in studies enriched with CRI and diabetic patients. However, a very recent study disputes such high incidence rates by demonstrating that patients receiving no radiocontrast media had a similar frequency of serum creatinine increases compared to a comparable group of historical CN patients. 6 This study emphasizes that conventional definitions of CN, eg, 25% increase in serum creatinine above baseline, may be too conservative. A retrospective study of 7586 patients showed 22% inhospital mortality in patients who developed CN vs. 1.4% in those who did not, after adjusting for comorbidities. Oneand 5-year mortality rates were also higher in the CN group (12.1% vs. 3.7% and 44.6% vs. 14.5%, respectively). 7 Another study of 1826 patients, who underwent coronary artery inte...

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Role of N‐acetylcysteine in prevention of contrast‐induced nephropathy after cardiovascular procedures: A meta‐analysis

Cited by 66 publications

References 21 publications

Glomerular Filtration Rate and Coronary Artery Disease Burden in Patients with Acute Coronary Syndrome

Glomerular Filtration Rate and Coronary Artery Disease Burden in Patients with Acute Coronary Syndrome

Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography

Evidence‐based approach for prevention of radiocontrast‐induced nephropathy

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