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

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

Research output: Contribution to journalArticle

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

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Acetylcysteine
Meta-Analysis
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Contrast Media
Odds Ratio
Sodium Bicarbonate
Ascorbic Acid
Tunica Media
Information Storage and Retrieval
MEDLINE
Libraries
Randomized Controlled Trials
Clinical Trials
Databases
Kidney
Mortality

ASJC Scopus subject areas

  • Internal Medicine

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Effectiveness of prevention strategies for contrast-induced nephropathy a systematic review and meta-analysis. / Subramaniam, Rathan M.; Suarez-Cuervo, Catalina; Wilson, Renee; Turban, Sharon I; Zhang, Allen; Sherrod, Cheryl; Aboagye, Jonathan; Eng, John; Choi, Michael J; Hutfless, Susan; Bass, Eric B.

In: Annals of Internal Medicine, Vol. 164, No. 6, 15.03.2016, p. 406-416.

Research output: Contribution to journalArticle

Subramaniam, Rathan M. ; Suarez-Cuervo, Catalina ; Wilson, Renee ; Turban, Sharon I ; Zhang, Allen ; Sherrod, Cheryl ; Aboagye, Jonathan ; Eng, John ; Choi, Michael J ; Hutfless, Susan ; Bass, Eric B. / Effectiveness of prevention strategies for contrast-induced nephropathy a systematic review and meta-analysis. In: Annals of Internal Medicine. 2016 ; Vol. 164, No. 6. pp. 406-416.
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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.",
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AU - Suarez-Cuervo, Catalina

AU - Wilson, Renee

AU - Turban, Sharon I

AU - Zhang, Allen

AU - Sherrod, Cheryl

AU - Aboagye, Jonathan

AU - Eng, John

AU - Choi, Michael J

AU - Hutfless, Susan

AU - Bass, Eric B

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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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