SynthesisBMC medicine2007
A meta-analysis of N-acetylcysteine in contrast-induced nephrotoxicity: unsupervised clustering to resolve heterogeneity.
Synthesis in BMC medicine, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
44 citing papers in PubMed, 8 syntheses or guidelines pooled it, 160 citations in OpenAlex.
- Association of N-acetylcysteine use with contrast-induced nephropathy: an umbrella review of meta-analyses of randomized clinical trials.Frontiers in medicine · 2023Pooled it
- Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017 : Expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine.Intensive care medicine · 2017Pooled it
- Pooled it
- Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version : JSN, JRS, and JCS Joint Working Group.Clinical and experimental nephrology · 2013Guideline
- Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version. JSN, JRS, and JCS Joint Working Group.Japanese journal of radiology · 2013Guideline
- Acute kidney injury.BMJ clinical evidence · 2011Pooled it
- Prevention of acute kidney injury and protection of renal function in the intensive care unit. Expert opinion of the Working Group for Nephrology, ESICM.Intensive care medicine · 2010Guideline
- The effects of steroids during sepsis depend on dose and severity of illness: an updated meta-analysis.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2009Pooled it
- N-acetylcysteine does not prevent contrast nephropathy in patients with renal impairment undergoing emergency CT: a randomized study.BMC nephrology · 2013Trial
- Mechanisms for an effect of acetylcysteine on renal function after exposure to radio-graphic contrast material: study protocol.BMC clinical pharmacology · 2012Trial
- Impact of N-acetylcysteine on contrast-induced nephropathy defined by cystatin C in patients with ST-elevation myocardial infarction undergoing primary angioplasty.Clinical research in cardiology : official journal of the German Cardiac Society · 2011Trial
- Trial
- Trial
- N-acetylcysteine effect on serum creatinine and cystatin C levels in CKD patients.Clinical journal of the American Society of Nephrology : CJASN · 2008Trial
- Update on Contrast-Induced Nephropathy: Recent Developments in Its Prevention, Early Diagnosis, and Therapy.Medicina (Kaunas, Lithuania) · 2026Review
- A Systematic Review of the Effect of N-Acetylcysteine on Serum Creatinine and Cystatin C Measurements.Kidney international reports · 2021Article
- Folic Acid Attenuates Contrast-Induced Nephropathy in Patients With Hyperhomocysteinemia Undergoing Coronary Catheterization: A Randomized Controlled Trial.Frontiers in cardiovascular medicine · 2021Article
- Article
- Adherence to prenatal iron-folic acid supplementation in low- and middle-income countries (LMIC): a protocol for systematic review and meta-analysis.Systematic reviews · 2018Article
- Update on the renal toxicity of iodinated contrast drugs used in clinical medicine.Drug, healthcare and patient safety · 2017Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundMeta-analyses of N-acetylcysteine (NAC) for preventing contrast-induced nephrotoxicity (CIN) have led to disparate conclusions. Here we examine and attempt to resolve the heterogeneity evident among these trials.
methodsTwo reviewers independently extracted and graded the data. Limiting studies to randomized, controlled trials with adequate outcome data yielded 22 reports with 2746 patients.
resultsSignificant heterogeneity was detected among these trials (I2 = 37%; p = 0.04). Meta-regression analysis failed to identify significant sources of heterogeneity. A modified L'Abbé plot that substituted groupwise changes in serum creatinine for nephrotoxicity rates, followed by model-based, unsupervised clustering resolved trials into two distinct, significantly different (p < 0.0001) and homogeneous populations (I2 = 0 and p > 0.5, for both). Cluster 1 studies (n = 18; 2445 patients) showed no benefit (relative risk (RR) = 0.87; 95% confidence interval (CI) 0.68-1.12, p = 0.28), while cluster 2 studies (n = 4; 301 patients) indicated that NAC was highly beneficial (RR = 0.15; 95% CI 0.07-0.33, p < 0.0001). Benefit in cluster 2 was unexpectedly associated with NAC-induced decreases in creatinine from baseline (p = 0.07). Cluster 2 studies were relatively early, small and of lower quality compared with cluster 1 studies (p = 0.01 for the three factors combined). Dialysis use across all studies (five control, eight treatment; p = 0.42) did not suggest that NAC is beneficial.
conclusionThis meta-analysis does not support the efficacy of NAC to prevent CIN.
Indexed as
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.