Is There Enough Evidence to Support Use of <i>N</i>-Acetylcysteine in Contrast-Induced Nephropathy?
Authors: Denise A. Gonzales, Robert A. Star, Steven J. Kern, Charles Natanson, Robert L. Danner
Journal: Annals of Internal Medicine (2008)

Letters5 August 2008Is There Enough Evidence to Support Use of N-Acetylcysteine in Contrast-Induced Nephropathy?Denise A. Gonzales, MD, Robert A. Star, MD, Steven J. Kern, BS, Charles Natanson, MD, and Robert L. Danner, MDDenise A. Gonzales, MDFrom Presbyterian Hospital, Albuquerque, NM 87110, and National Institutes of Health, Bethesda, MD 20892.Search for more papers by this author, Robert A. Star, MDFrom Presbyterian Hospital, Albuquerque, NM 87110, and National Institutes of Health, Bethesda, MD 20892.Search for more papers by this author, Steven J. Kern, BSFrom Presbyterian Hospital, Albuquerque, NM 87110, and National Institutes of Health, Bethesda, MD 20892.Search for more papers by this author, Charles Natanson, MDFrom Presbyterian Hospital, Albuquerque, NM 87110, and National Institutes of Health, Bethesda, MD 20892.Search for more papers by this author, and Robert L. Danner, MDFrom Presbyterian Hospital, Albuquerque, NM 87110, and National Institutes of Health, Bethesda, MD 20892.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-3-200808050-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:A recent meta-analysis by Kelly and colleagues (1) of treatments to prevent contrast-induced nephrotoxicity concluded that N-acetylcysteine was renoprotective; prophylaxis was recommended “particularly in high-risk patients, given its low cost, availability, and few side effects.” At least 13 other meta-analyses have examined this issue, and 6 of these, including 1 that we performed (2), reached different conclusions.Like Kelly and colleagues, we found statistically significant unexplained heterogeneity among 22 published trials (2). This heterogeneity and most of the apparent benefit of N-acetylcysteine was attributable to 4 small, relatively early trials (open circles in Figure; circles weighted by ...References1. Kelly AM, Dwamena B, Cronin P, Bernstein SJ, Carlos RC. Meta-analysis: effectiveness of drugs for preventing contrast-induced nephropathy. Ann Intern Med. 2008;148:284-94. [PMID: 18283206] LinkGoogle Scholar2. Gonzales DA, Norsworthy KJ, Kern SJ, Banks S, Sieving PC, Star RA, et al. A meta-analysis of N-acetylcysteine in contrast-induced nephrotoxicity: unsupervised clustering to resolve heterogeneity. BMC Med. 2007;5:32. [PMID: 18001477] CrossrefMedlineGoogle Scholar3. Hoffmann U, Fischereder M, Krüger B, Drobnik W, Krämer BK. The value of N-acetylcysteine in the prevention of radiocontrast agent-induced nephropathy seems questionable. J Am Soc Nephrol. 2004;15:407-10. [PMID: 14747387] CrossrefMedlineGoogle Scholar4. Poletti PA, Saudan P, Platon A, Mermillod B, Sautter AM, Vermeulen B, et al. I.v. N-acetylcysteine and emergency CT: use of serum creatinine and cystatin C as markers of radiocontrast nephrotoxicity. AJR Am J Roentgenol. 2007;189:687-92. [PMID: 17715118] CrossrefMedlineGoogle Scholar5. Lynch RM, Robertson R. Anaphylactoid reactions to intravenous N-acetylcysteine: a prospective case controlled study. Accid Emerg Nurs. 2004;12:10-5. [PMID: 14700565] CrossrefMedlineGoogle Scholar6. Appelboam AV, Dargan PI, Knighton J. Fatal anaphylactoid reaction to N-acetylcysteine: caution in patients with asthma. Emerg Med J. 2002;19:594-5. [PMID: 12421803] CrossrefMedlineGoogle Scholar7. Molnár Z, Shearer E, Lowe D. N-Acetylcysteine treatment to prevent the progression of multisystem organ failure: a prospective, randomized, placebo-controlled study. Crit Care Med. 1999;27:1100-4. [PMID: 10397212] CrossrefMedlineGoogle Scholar8. Peake SL, Moran JL, Leppard PI. N-acetyl-L-cysteine depresses cardiac performance in patients with septic shock. Crit Care Med. 1996;24:1302-10. [PMID: 8706483] CrossrefMedlineGoogle Scholar9. Morris PE, Papadakos P, Russell JA, Wunderink R, Schuster DP, Truwit JD, et al. A double-blind placebo-controlled study to evaluate the safety and efficacy of L-2-oxothiazolidine-4-carboxylic acid in the treatment of patients with acute respiratory distress syndrome. Crit Care Med. 2008;36:782-8. [PMID: 18209670] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Presbyterian Hospital, Albuquerque, NM 87110, and National Institutes of Health, Bethesda, MD 20892.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMeta-analysis: Effectiveness of Drugs for Preventing Contrast-Induced Nephropathy Aine M. Kelly , Ben Dwamena , Paul Cronin , Steven J. Bernstein , and Ruth C. Carlos Is There Enough Evidence to Support Use of N-Acetylcysteine in Contrast-Induced Nephropathy? Giuseppe Ferrante , Didier Locca , and Peter Barlis Is There Enough Evidence to Support Use of N-Acetylcysteine in Contrast-Induced Nephropathy? Otavio Berwanger Is There Enough Evidence to Support Use of N-Acetylcysteine in Contrast-Induced Nephropathy? Aine M. Kelly , Ben Dwamena , and Ruth C. Carlos Is There Enough Evidence to Support Use of N-Acetylcysteine in Contrast-Induced Nephropathy? Hariprasad Trivedi Metrics Cited By1. Contrast-induced Acute Kidney Injury 5 August 2008Volume 149, Issue 3Page: 213-214KeywordsAcute respiratory distress syndromeCreatinineOutpatientsPatient advocacyPopulation statisticsProphylaxisRespiratory system proceduresSafety ePublished: 5 August 2008 Issue Published: 5 August 2008 CopyrightCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...