Eficacia de la n-acetilcisteína en nefropatía inducida por contraste en pacientes con alteración renal previa: meta-análisis. (METACIAKI)

Abstract

BACKGROUND: The contrast induced acute kidney injury is considered as a decrease of the renal function after 48 hours of administration of contrast media. To prevent this event several clinical interventions had been studied, like the N-Acetylcysteine (NAC) administration, prior to the diagnostic procedure. Several meta-analysis compare different clinical interventions to prevent CIAKI with inconclusive results. The present meta-analysis examines the evidence of the efficacy of NAC administration to prevent CIAKI in patients with previous renal failure. METHODOLOGY: Three independent reviewers analyzed different RCT studies, already published and also in gray literature, about population who presented nephropathy in languages such as: English, Spanish, Portuguese, Italian, German and French, which compared NAC versus hydratation or placebo. RESULTS: The found studies were published between the years 2000 and 2010. We analyzed 37 studies with 6022 patients. The reliability analysis was performed using the intraclass correlation for three subjects (kappa r=0.97 [IC95% 0.93-0.99]). Patients with kidney disease who were administered NAC before the procedure had 34% lower probability of acute renal failure, with adjusted OR by publication bias 0.66 [IC95% 0.50-0.88] (p=0.002). When performing sensitivity analysis on the Jadad scale, it found that results in studies of low quality are not significant (p=0.202). CONCLUSION: The results support the association between treatment prevention with N-Acetylcysteine and less frequency of contrast induced acute kidney injury in renal patients.