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

Objectives The purpose 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 analysis was performed using the Review Manager 5.2. Results Total 6 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). Conclusions 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.