The effectiveness of N -acetylcysteine in preventing contrast-induced nephropathy in patients undergoing contrast-enhanc
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NEPHROLOGY - ORIGINAL PAPER
The effectiveness of N-acetylcysteine in preventing contrast-induced nephropathy in patients undergoing contrast-enhanced computed tomography: a meta-analysis of randomized controlled trials Mei-Yi Wu • Hui-Fen Hsiang • Chung-Shun Wong • Min-Szu Yao • Yun-Wen Li • Chao-Ying Hsiang • Chyi-Huey Bai • Yung-Ho Hsu • Yuh-Feng Lin • Ka-Wai Tam
Received: 12 July 2012 / Accepted: 12 December 2012 Ó Springer Science+Business Media Dordrecht 2012
Abstract Background N-Acetylcysteine (NAC) is reported to have potential for preventing of contrast-induced nephropathy (CIN) in patients undergoing coronary angiography. However, the effectiveness of NAC in preventing CIN in patients undergoing contrastenhanced computed tomography (CT) is still controversial. We conducted a meta-analysis of relevant randomized controlled trials (RCTs) to further examine this issue. Methods RCTs were identified by computerized searching in PubMed, EMBASE, SCOPUS, and Cochrane databases. Two reviewers independently assessed the methodological quality of each study. A meta-analysis was performed to evaluate the effectiveness of NAC in preventing CIN in patients
undergoing CT. The primary outcome was the incidence of contrast-induced nephropathy, and the requirement for dialysis. The secondary outcome was the change of serum creatinine. Results Six randomized controlled trials were identified with a total of 496 patients meeting the criteria for this study. Prophylactic administration of NAC in patients with serum creatinine above 1.2 mg/dL undergoing contrast-enhanced CT, along with hydration, reduced the risk of CIN (relative risk 0.20; 95 % confidence interval: 0.07–0.57). Requirement for dialysis was not significantly different between the NAC group and the control group. Conclusions This review provides evidence of the efficacy of NAC in preventing the incidence of CIN
M.-Y. Wu Y.-H. Hsu Y.-F. Lin Division of Nephrology, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, Taipei, Taiwan
C.-H. Bai School of Public Health, Taipei Medical University, Taipei, Taiwan
H.-F. Hsiang Y.-W. Li C.-Y. Hsiang Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan C.-S. Wong Department of Emergency Medicine, Taipei Medical University, Shuang Ho Hospital, Taipei, Taiwan
K.-W. Tam (&) Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, No. 252 Wu-Hsing Street, Taipei 11031, Taiwan e-mail: [email protected] K.-W. Tam Center for Evidence-Based Medicine, Taipei Medical University, Taipei, Taiwan
M.-S. Yao Department of Radiology, Taipei Medical University, Wan Fang Hospital, Taipei, Taiwan
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and recommends that NAC be more widely used in high-risk patients undergoing contrast-enhanced CT. On the basis of the evidence reviewed, further research involving large RCTs may be warranted. Keywords N-Acetylcysteine Contrast-induced nephropathy Computed tomography Meta-analysis
Introduction Contrast-induced nephrop
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