Shira I. Moos MD, MMedSc, Presenter: Nothing to Disclose

Roderick S. de Weijert, Abstract Co-Author: Nothing to Disclose

Jaap Stoker MD, PhD, Abstract Co-Author: Research Consultant, Robarts Clinical Trials

Shandra Bipat MS, Abstract Co-Author: Nothing to Disclose

To summarize difference in CIN incidence between prevention regimens (i.e. prophylactic intravenous hydration) with addition of anti-oxidants in patients undergoing intravenous CECT.

We performed a review and meta-analysis according to the preferred reporting in systematic reviews, meta-analysis (PRISMA) guidelines. We searched MEDLINE, EMBASE and Cochrane (2002 till November 2013). Randomised controlled trials (RCTs) studying CIN prevention in CECT were selected. Data were pooled (intervention versus control) and analysed by a fixed- or random-effects models depending on heterogeneity. 

We included eight RCTs. The intervention group comprised 655 patients receiving N-acetylcysteine, Vitamin E or alprostadil combined with saline. The control group comprised 667 patients receiving saline. The risk-difference in CIN incidence between intervention and the control groups was -0.08(95%CI:-0.11--0.04), p<0.0001). Subgroup analysis for N-acetylcysteine only as intervention compared to the control group showed a difference in CIN incidence; risk difference: -0.09(95%CI:-0.16- -0.01), p=0.03). Patients with kidney disease showed a risk-difference in CIN of -0.10(95%CI:-0.16--0.04), p=0.001), for N-acetylcysteine only this was: -0.10(95%CI:-0.16- -0.04), p=0.001 as well. The risk difference in patients undergoing emergency CECT was -0.04(95%CI:-0.16-0.08), p=0.49). 

Hydration with prevention agents, or more specifically N-acetylcysteine, seems to decrease CIN incidence when compared to hydration only. RCTs with controls not receiving any prevention are lacking. 

Addition of anti-oxidant to contrast induced nephropathy (CIN) prevention regimens has become part of daily clinical practice. However evidence for the addition of these agents in patients undergoing contrast enhanced computed tomography (CECT) is ambiguous. The results of our meta-analysis indicate if addition of anti-oxidants for CIN prevention is effective. 

Moos, S, de Weijert, R, Stoker, J, Bipat, S, Contrast Induced Nephropathy Prevention Regimens for Patients Undergoing Intravenous Contrast Enhanced Computed Tomography: A Meta-analysis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045523.html