Effectiveness of prevention strategies for contrast-induced nephropathy a systematic review and meta-analysis

Rathan M. Subramaniam, Catalina Suarez-Cuervo, Renee F. Wilson, Sharon Turban, Allen Zhang, Cheryl Sherrod, Jonathan Aboagye, John Eng, Michael J. Choi, Susan Hutfless, Eric B. Bass

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88 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)406-416
Number of pages11
JournalAnnals of Internal Medicine
Volume164
Issue number6
DOIs
StatePublished - Mar 15 2016

ASJC Scopus subject areas

  • Internal Medicine

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    Subramaniam, R. M., Suarez-Cuervo, C., Wilson, R. F., Turban, S., Zhang, A., Sherrod, C., Aboagye, J., Eng, J., Choi, M. J., Hutfless, S., & Bass, E. B. (2016). Effectiveness of prevention strategies for contrast-induced nephropathy a systematic review and meta-analysis. Annals of Internal Medicine, 164(6), 406-416. https://doi.org/10.7326/M15-1456