Sodium Bicarbonate Plus N-Acetylcysteine Prophylaxis A Meta-Analysis

Objectives We sought to conduct a meta-analysis to compare N-acetylcysteine (NAC) in combination with sodium bicarbonate (NaHCO,) for the prevention of contrast-induced acute kidney injury (AKI). Background Contrast-induced AKI is a serious consequence of cardiac catheterizations and percutaneous coronary interventions (PCI). Despite recent supporting evidence for combination therapy, not enough has been done to prevent the occurrence of contrast-induced AKI prophylactically. Methods Published randomized controlled trial data were collected from OVID/PubMed, Web of Science, and conference abstracts. The outcome of interest was contrast-induced AKI, defined as a >= 25% or >= 0.5 mg/dl increase in serum creatinine from baseline. Secondary outcome was renal failure requiring dialysis. Results Ten randomized controlled trials met our criteria. Combination treatment of NAC with intravenous NaHCO3 reduced contrast-induced AKI by 35% (relative risk: 0.65; 95% confidence interval: 0.40 to 1.05). However, the combination of N-acetylcysteine plus NaHCO3 did not significantly reduce renal failure requiring dialysis (relative risk: 0.47; 95% confidence interval: 0.16 to 1.41). Conclusions Combination prophylaxis with NAC and NaHCO3 substantially reduced the occurrence of contrast-induced AKI overall but not dialysis-dependent renal failure. Combination prophylaxis should be incorporated for all high-risk patients (emergent cases or patients with chronic kidney disease) and should be strongly considered for all interventional radio-contrast procedures. (J Am Coll Cardiol Intv 2009;2:1116-24) (C) 2009 by the American College of Cardiology Foundation