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

Abstract Background: Radiocontrast nephropathy (RCN) is a common cause of hospital-acquired acute renal failure. Results of several studies using N -acetylcysteine (NAC) for the prevention of RCN have yielded conflicting results. We performed a meta-analysis of group data extracted from previously published studies to assess the effect of NAC on the prevention of RCN in patients with pre-existing chronic kidney disease (CKD). Methods: Ovid's multidatabase search for MEDLINE, Cochrane Central Registry of Controlled Trials, Cochrane Database of Systematic Reviews, and HealthSTAR were used to identify candidate articles. Abstracts from proceedings of scientific meetings also were screened. We selected blinded and unblinded randomized controlled trials (RCTs) performed in humans 18 years and older with pre-existing CKD, defined by a mean baseline serum creatinine level of 1.2 mg/dL or greater (≥106.1 μmol/L) or creatinine clearance less than 70 mL/min ( P = 0.007). In a sensitivity analysis that included 4 additional RCTs published in abstract form, RR remained significant at 0.55 (95% CI, 0.34 to 0.91; P = 0.020). Conclusion: NAC reduces the risk for RCN in patients with CKD.