TY - JOUR
T1 - Effectiveness of prevention strategies for contrast-induced nephropathy a systematic review and meta-analysis
AU - Subramaniam, Rathan M.
AU - Suarez-Cuervo, Catalina
AU - Wilson, Renee F.
AU - Turban, Sharon
AU - Zhang, Allen
AU - Sherrod, Cheryl
AU - Aboagye, Jonathan
AU - Eng, John
AU - Choi, Michael J.
AU - Hutfless, Susan
AU - Bass, Eric B.
PY - 2016/3/15
Y1 - 2016/3/15
N2 - Background: N-acetylcysteine, sodium bicarbonate, statins, and ascorbic acid have been studied for reducing contrastinduced nephropathy (CIN). Purpose: To evaluate the comparative effectiveness of interventions to reduce CIN in adults receiving contrast media. Data Sources: MEDLINE, EMBASE, Cochrane Library, Clinical- Trials.gov, and Scopus databases through June 2015. Risk of bias and overall strength of evidence (SOE) of studies were assessed. Study Selection: Randomized, controlled trials of N-acetylcysteine, sodium bicarbonate, statins, or ascorbic acid that used intravenous (IV) or intra-arterial contrast media and defined CIN with enough data for meta-analysis. Data Extraction: Two reviewers independently extracted data and assessed study quality. Data Synthesis: Low-dose N-acetylcysteine plus IV saline compared with IV saline (risk ratio [RR], 0.75 [95% CI, 0.63 to 0.89]; low SOE), N-acetylcysteine plus IV saline compared with IV saline in patients receiving low-osmolar contrast media (RR, 0.69 [CI, 0.58 to 0.84]; moderate SOE), and statins plus N-acetylcysteine plus IV saline versus N-acetylcysteine plus IV saline (RR, 0.52 [CI, 0.29 to 0.93]; low SOE) had clinically important and statistically significant benefits. The following 3 comparisons suggested a clinically important difference that was not statistically significant: sodium bicarbonate versus IV saline in patients receiving lowosmolar contrast media (RR, 0.65 [CI, 0.33 to 1.25]; low SOE), statins plus IV saline versus IV saline (RR, 0.68 [CI, 0.39 to 1.20]; low SOE), and ascorbic acid versus IV saline (RR, 0.72 [CI, 0.48 to 1.01]; low SOE). Strength of evidence was generally insufficient for comparisons of the need for renal replacement, cardiac events, and mortality. Limitation: Too few studies were done in patients receiving IV contrast media. Conclusion: The greatest reduction in CIN was seen with N-acetylcysteine plus IV saline in patients receiving LOCM and with statins plus N-acetylcysteine plus IV saline.
AB - Background: N-acetylcysteine, sodium bicarbonate, statins, and ascorbic acid have been studied for reducing contrastinduced nephropathy (CIN). Purpose: To evaluate the comparative effectiveness of interventions to reduce CIN in adults receiving contrast media. Data Sources: MEDLINE, EMBASE, Cochrane Library, Clinical- Trials.gov, and Scopus databases through June 2015. Risk of bias and overall strength of evidence (SOE) of studies were assessed. Study Selection: Randomized, controlled trials of N-acetylcysteine, sodium bicarbonate, statins, or ascorbic acid that used intravenous (IV) or intra-arterial contrast media and defined CIN with enough data for meta-analysis. Data Extraction: Two reviewers independently extracted data and assessed study quality. Data Synthesis: Low-dose N-acetylcysteine plus IV saline compared with IV saline (risk ratio [RR], 0.75 [95% CI, 0.63 to 0.89]; low SOE), N-acetylcysteine plus IV saline compared with IV saline in patients receiving low-osmolar contrast media (RR, 0.69 [CI, 0.58 to 0.84]; moderate SOE), and statins plus N-acetylcysteine plus IV saline versus N-acetylcysteine plus IV saline (RR, 0.52 [CI, 0.29 to 0.93]; low SOE) had clinically important and statistically significant benefits. The following 3 comparisons suggested a clinically important difference that was not statistically significant: sodium bicarbonate versus IV saline in patients receiving lowosmolar contrast media (RR, 0.65 [CI, 0.33 to 1.25]; low SOE), statins plus IV saline versus IV saline (RR, 0.68 [CI, 0.39 to 1.20]; low SOE), and ascorbic acid versus IV saline (RR, 0.72 [CI, 0.48 to 1.01]; low SOE). Strength of evidence was generally insufficient for comparisons of the need for renal replacement, cardiac events, and mortality. Limitation: Too few studies were done in patients receiving IV contrast media. Conclusion: The greatest reduction in CIN was seen with N-acetylcysteine plus IV saline in patients receiving LOCM and with statins plus N-acetylcysteine plus IV saline.
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U2 - 10.7326/M15-1456
DO - 10.7326/M15-1456
M3 - Review article
C2 - 26830221
AN - SCOPUS:84960898146
SN - 0003-4819
VL - 164
SP - 406
EP - 416
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 6
ER -