Oral N-acetylcysteine Combined With Saline Hydration For The Prevention Of Contrast-induced Nephropathy:A Meta-analysis Of Randomized Controlled Trials

Objective:With the improvement of living standards,the people of coronary heart disease is increasing all over the world.At the same time,coronary angiography(CAG)or percutaneous coronary intervention(PCI)has also increased.The occurrence of Contrast-induced nephropathy(CIN)which is the third major cause of hospital-acquired acute renal failure has been paid more and more attentions.As we know,CIN not only prolongs the time of hospitalization,but also leads to serious influences on the prognosis of the patients.It is a question about how to prevent the happening of CIN.As a kind of Antioxidant,N-Acetylcysteine(NAC)may protect the kidney via cleaning the reactive oxygen species(ROS).However,there is still no a final conclusion whether the NAC works.Therefore,the aim of this study was to evaluate the effectiveness of NAC about preventing Contrast-induced nephropathy during CAG or PCI.Methods:A systematic literature search of the PubMed,Embase and Cochrane Library databases of clinical trials,Web of science,Wanfang database was conducted using specific search terms.Eligible studies were the randomized controlled trials regarding about the effects of NAC preventing Contrast-induced nephropathy,reported from January 1,2002 to December 31,2017.We made the data analysis through RevMan5.3.Firstly,we analyzed heterogeneity of the data.According to whether there was heterogeneity,we choosed a fixed effect model or a random effect model.If heterogeneity existed,we do heterogeneity analysis.And then,we evaluate the percentage of Contrast-induced nephropathy by comparing the experimental group and the control group,specially in the patients with high risks.Result:In this study,13 trials involving 2025 patients were analyzed.Meta-analysis has shown that there is no significant to prevent Contrast-induced nephropathy for oralNAC: [RR=0.78,95%CI(0.61,1.00),p=0.05].In the patients with Chronic kidney disease(CKD): [RR=0.88,95%CI(0.53,1.48),p=0.64].In the patients with Diabetes mellitus(DM): [RR=1.03,95%CI(0.47,2.26),p=0.94].Conclusions:The Meta-analysis shows that oral N-acetylcysteine has no significant benefits for the prevention of Contrast-induced nephropathy on the basis of the intravenous Isotonic saline.In high-risk patients,oral NAC is not more effective in preventing the occurrence of Contrast-induced nephropathy yet.Furthermore,more high quality researches for different populations,different doses and random double blindness are still needed.