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Is There Enough Evidence to Support Use of N-Acetylcysteine in Contrast-Induced Nephropathy?
- Denise A. Gonzales, MD;
- Robert A. Star, MD;
- Steven J. Kern, BS;
- Charles Natanson, MD; and
- Robert L. Danner, MD
- From Presbyterian Hospital, Albuquerque, NM 87110, and National Institutes of Health, Bethesda, MD 20892.
TO THE EDITOR:
A recent meta-analysis by Kelly and colleagues (1) of treatments to prevent contrast-induced nephrotoxicity concluded that N-acetylcysteine was renoprotective; prophylaxis was recommended “particularly in high-risk patients, given its low cost, availability, and few side effects.” At least 13 other meta-analyses have examined this issue, and 6 of these, including 1 that we performed (2), reached different conclusions.
Like Kelly and colleagues, we found statistically significant unexplained heterogeneity among 22 published trials (2). This heterogeneity and most of the apparent benefit of N-acetylcysteine was attributable to 4 small, relatively early trials (open circles in Figure; circles weighted by trial size). In these overly influential trials, N-acetylcysteine …
