AJM onlineClinical research studyHigh-dose N-acetylcysteine for the Prevention of Contrast-induced Nephropathy
Section snippets
Materials and Methods
Our prespecified inclusion criteria were as follows: adult subjects; English language literature; administration of high-dose N-acetylcysteine a priori defined as a daily dose greater than 1200 mg or a single periprocedural dose greater than 600 mg, periprocedural being described as immediately or within 4 hours of the planned contrast exposure (although the inherent arbitrariness of the high-dose definition is recognized, it was considered that a higher dose either as an individual or a
Results
Sixteen comparisons of patients randomized to high-dose N-acetylcysteine versus controls met our prespecified inclusion criteria with a total sample size of 1677 subjects (842 assigned to high-dose N-acetylcysteine and 835 assigned to the control arm).8, 9, 10, 11, 13, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26 The results of the literature search are shown in Figure 1.27
The subject population was derived from 11 countries, and the majority of patients had some degree of renal insufficiency. The
Discussion
The role of N-acetylcysteine in the prevention of contrast-induced nephropathy has been controversial. After the original positive report, there have been several studies showing lack of benefit. Several large meta-analyses consistently found significant heterogeneity (variation of effect across studies greater than can be expected by chance) and thus could not reconcile the issue. Our analysis of the effect of a prespecified high-dose N-acetylcysteine did not find significant heterogeneity and
Conclusions
The present analysis suggests that N-acetylcysteine at individual periprocedural doses exceeding 600 mg or daily doses exceeding 1200 mg decreases the incidence of contrast-induced nephropathy. Further studies need to investigate whether these doses lead to improvement in other outcomes associated with post-contrast acute kidney injury, such as mortality.
Acknowledgments
We thank Dr Khalili for providing clarification regarding timing of N-acetylcysteine administration that resulted in inclusion of their study in the analysis. We also thank Drs Allaqaband and Poletti for providing additional unpublished information and Dr Miner for providing clarification regarding their respective studies.
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Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and played a role in writing this manuscript.