Subramaniam R et al. Ann Intern Med.
Published online 2 February 2016 - doi:10.7326/M15-1456
"Background: N-acetylcysteine, sodium bicarbonate, statins, and ascorbic acid have been studied for reducing contrast-induced nephropathy (CIN).
Purpose: To evaluate the comparative effectiveness of interventions to reduce CIN in adults receiving contrast media.
Data Sources: MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov, and Scopus databases through June 2015. Risk of bias of studies and overall strength of evidence (SOE) were assessed.
Conclusion: The greatest reduction in CIN was seen with N-acetylcysteine in patients receiving LOCM and with statins plus N-acetylcysteine.
Discussion
Applying existing evidence to patients receiving IV contrast media is difficult because most studies involved patients receiving IA contrast media for cardiovascular procedures. More research is needed to determine the effectiveness of interventions for preventing CIN in patients receiving IV contrast media because little evidence exists on the effectiveness of different regimens for hydration when administering contrast media.
Our search was broad but our meta-analysis may overestimate the effect of prevention strategies to reduce CIN if studies with negative results were not reported in our sources. The studies span over 2 decades, and there may have been changes in the practice of CIN prevention, such as increased screening, variation in definition of acute kidney injury, and variation in hydration, over time. Such changes could contribute to differences in outcomes.
This comprehensive review highlights the generally low SOE on interventions for preventing CIN while indicating that the greatest reduction in CIN risk has been achieved with low-dose N-acetylcysteine in patients receiving LOCM or with statins plus N-acetylcysteine."