Table 1.
Randomized controlled trials with N-acetylcysteine as a prophylactic measure to prevent contrast-induced nephouropathy
| Reference | Year | Number of patients | Reason for contrast administration | Study design | Dose/timing/route of administration of NAC | Hydration regimen | Main outcomea |
| [22] | 2000 | 83 | CT | NAC + hydration versus hydration | 600 mg po, twice daily, day before and on day of contrast | 1 ml/kg per hour 0.45% saline 12 hours before – 12 hours after contrast | RR 0.11 (95% CI 0.02–0.86) |
| [23] | 2002 | 123 | Various | NAC + hydration versus hydration | 600 mg po, twice daily, day before and on day of contrast | 1 ml/kg per hour 0.45% saline 12 hours before – 12 hours after contrast | RR 1.18 (95% CI 0.45–3.12) |
| [24] | 2002 | 183 | Various | NAC + hydration versus hydration | 600 mg po, twice daily, day before and on day of contrast | 1 ml/kg per hour 0.45% saline 12 hours before – 12 hours after contrast | RR 0.59 (95% CI 0.22–1.57) |
| [25] | 2002 | 54 | CAG | NAC + hydration versus hydration | 600 mg po, twice daily, day before and on day of contrast | 1 ml/kg per hour 0.45% saline 12 hours before – 12 hours after contrast | RR 0.18 (95% CI 0.04–0.72) |
| [26] | 2002 | 79 | CAG | NAC + hydration versus hydration | 1200 mg po, 1 hour before and3 hours after contrast | 1 ml/kg per hour 0.45% saline 12 hours before – 12 hours after contrast | RR 1.2 (95% CI 0.55–2.63) |
| [27] | 2002 | 121 | CAG | NAC + hydration versus hydration | 400 mg po, twice daily, day before and on day of contrast | 1 ml/kg per hour 0.45% saline 12 hours before – 12 hours after contrast | RR 0.14 (95% CI 0.03–0.57) |
| [28] | 2003 | 80 | CAG | NAC + hydration versus hydration | 150 mg/kg iv, immediately before contrast | NAC group: 500 ml 0.9% saline before and 500 ml 0.9% saline 4 hours after contrast | RR 1.20 (95% CI 0.55–2.63) |
| Control group: 1 ml/kg per hour 0.9% saline 12 hours before – 12 hours after | |||||||
| [29] | 2003 | 179 | Elective CAG | NAC + hydration versus hydration | 600 mg po, twice daily day before and on day of contrast | 75 ml/hour 0.45% saline 12 hours before – 12 hours after contrast | 13% versus 12%; NS |
| [30] | 2003 | 200 | Elective CAG | NAC + hydration versus hydration | 600 mg po, twice daily, day before and on day of contrast | 1 ml/kg per hour 0.9% saline 12 hours before – 6 hours after contrast | RR 0.32 (95% CI 0.11–0.96) |
| [31] | 2003 | 108 | CAG | NAC + hydration versus hydration | 1200 mg iv, 12 hours before and immediately after contrast | 20 ml/hour 5% dextrose 12 hours before – 12 hours after contrast | 3.8% versus 5.9%; NS |
| [32] | 2003 | 43 | Elective CAG | NAC + hydration versus hydration | 600 mg po, twice daily, day before contrast; and 600 mg po three times daily, day of contrast | 1–2 ml/kg per hour 0.45% saline for 4–12 hours before – 75 ml/hour 0.45% saline for 12 hours after contrast | 4.8% versus 31.8%;P = 0.046 |
| [13] | 2003 | 96 | Elective CAG | NAC + hydration versus hydration | 375 mg po, twice daily, day before and on day of contrast | 1 ml/kg per hour 0.45% saline 12 hours before – 12 hours after contrast | RR 1.28 (95% CI 0.30–5.41) |
| [33] | 2004 | 223 | Various | Low-dose versus high-dose NAC | 600 mg po twice daily versus 1200 mg po twice daily, day before and on day of contrast | 1 ml/kg per hour 0.45% saline 12 hours before – 12 hours after contrast | 11% versus 3.5%; P = 0.038 |
| [34] | 2004 | 91 | Cardiovascular procedures | NAC + hydration versus hydration | 400 mg po, three times daily, day before and on day of contrast | 100 ml/hour 0.9% saline 12 hours before – 12 hours after contrast | 17.4% versus 13.3%; NS |
| [35] | 2004 | 80 | CAG | NAC + hydration versus hydration | 600 mg po, three times daily, day before and on day of contrast | 1 ml/kg per hour 0.45% saline 12 hours before – 12 hours after contrast | 10% versus 8%; NS |
aIncidences of contrast-induced nephouropathy. CAG, coronary angiography; CI, confidence interval; CT, computed tomography, iv, intravenously; NAC, N-acetylcysteine; NS, not significant; po, by mouth; RR, relative risk.