N-acetylcysteine versus ascorbic acid or N-acetylcysteine plus ascorbic acid in preventing contrast-induced nephropathy: A meta-analysis.

AIM: The purpose of the present study was to evaluate the efficacy of N-acetylcysteine (NAC) versus ascorbic acid (VC) or NAC plus (+) VC on the prevention of contrast-induced nephropathy (CIN) in patients undergoing contrast administration.

METHODS: We searched databases including Medline, Embase and Cochrane Library up to Feb 22 (th), 2017. Pooled risk ratios (RRs) or weighted mean difference (WMD) with their 95% confidence intervals (CIs) were calculated using fixed-effects model or random-effects model when appropriate. All analyses were performed using the Review Manager 5.2.

RESULTS: A totalof six randomized controlled trials including 919 patients (478 cases received NAC administration and 441 cases received VC or NAC + VC administration) were considered in the meta-analysis. Results showed that there was no significant difference in preventing CIN between NAC and NAC + VC administration as well as between NAC and VC administration. In addition, significant difference was found in serum creatinine level between NAC and VC or NAC + VC administration (WMD = -0.31, 95% CI: -0.48 to -0.14, P = 0.0003) as well as NAC and VC administration (WMD = -0.05, 95% CI: -0.08 to -0.02, P = 0.002). Besides, NAC and NAC + VC administration also has significant difference (WMD = -0.72, 95% CI: -1.33 to -0.11, P = 0.02).

CONCLUSION: In conclusion, the prevention effect of NAC administration and VC or NAC + VC administration on CIN was similar in patients undergoing contrast administration. But NAC administration was associated with a significantly lower serum creatinine levels compared to VC and NAC + VC administration.