Author + information
- Received July 14, 2009
- Accepted July 25, 2009
- Published online November 1, 2009.
- Jeremiah R. Brown, PhD⁎,‡,⁎ (, )
- Clay A. Block, MD†,
- David J. Malenka, MD‡,
- Gerald T. O'Connor, PhD, ScD⁎,
- Anton C. Schoolwerth, MD, MSHA† and
- Craig A. Thompson, MD, MMSc§
- ↵⁎Reprint requests and correspondence:
Dr. Jeremiah R. Brown, Clinical Research Section, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire 03756
Objectives We sought to conduct a meta-analysis to compare N-acetylcysteine (NAC) in combination with sodium bicarbonate (NaHCO3) for the prevention of contrast-induced acute kidney injury (AKI).
Background Contrast-induced AKI is a serious consequence of cardiac catheterizations and percutaneous coronary interventions (PCI). Despite recent supporting evidence for combination therapy, not enough has been done to prevent the occurrence of contrast-induced AKI prophylactically.
Methods Published randomized controlled trial data were collected from OVID/PubMed, Web of Science, and conference abstracts. The outcome of interest was contrast-induced AKI, defined as a ≥25% or ≥0.5 mg/dl increase in serum creatinine from baseline. Secondary outcome was renal failure requiring dialysis.
Results Ten randomized controlled trials met our criteria. Combination treatment of NAC with intravenous NaHCO3 reduced contrast-induced AKI by 35% (relative risk: 0.65; 95% confidence interval: 0.40 to 1.05). However, the combination of N-acetylcysteine plus NaHCO3 did not significantly reduce renal failure requiring dialysis (relative risk: 0.47; 95% confidence interval: 0.16 to 1.41).
Conclusions Combination prophylaxis with NAC and NaHCO3 substantially reduced the occurrence of contrast-induced AKI overall but not dialysis-dependent renal failure. Combination prophylaxis should be incorporated for all high-risk patients (emergent cases or patients with chronic kidney disease) and should be strongly considered for all interventional radio-contrast procedures.
Funding for this research was provided by a National Research Service Award post-doctoral training grant from the Agency for Healthcare Research and Quality, T32HS000070.
- Received July 14, 2009.
- Accepted July 25, 2009.
- American College of Cardiology Foundation