Abstract: SA-PO034

The Effect of N-Acetylcysteine on Serum Creatinine: A Systematic Review of the Evidence

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Huang, Johnny, University of Ottawa, Ottawa, Ontario, Canada
  • Akbari, Ayub, University of Ottawa, Ottawa, Ontario, Canada
  • Hiremath, Swapnil, University of Ottawa, Ottawa, Ontario, Canada
Background

Contrast-induced acute kidney injury (CI-AKI) is a major iatrogenic concern with contrast imaging procedures. N-acetylcysteine (NAC) has been tested in prevention of CI-AKI with conflicting reports of efficacy, and there has not been a good scientific explanation for this heterogeneity reported in the literature. Interference of NAC with serum creatinine measurement has been proposed to be one explanation, but the research on this topic has been discrepant. One possibility is that the interference may vary with the type of assay used to measure creatinine.

Objective: What is the effect of NAC on serum creatinine, administered in the absence of any other confounding events (eg contrast administration, surgery)?

Methods

A systematic search was performed in MEDLINE, EMBASE, and Cochrane Library to identify studies with participants receiving NAC and before/after serum creatinine measurements, without confounding factors . Two authors independently screened the citations, and data of relevant articles was extracted for meta-analysis.

Results

The literature search produced 503 citations, of which 6 were eligible and included in the review. There is clinical heterogeneity in the studies in terms of study population (healthy volunteers, patients with normal and decreased kidney function), dose of NAC used and method of creatinine estimation. Overall, all studies did show a numerically lower creatinine after NAC administration, ranging from 0.35 to 31.1 µmol/L. The summary weighted mean difference was -2.8 µmol/L (95% CI -0.001, -5.6, p = 0.05). There was no statistical heterogeneity in the results.

Conclusion

Conclusion:
There is a small decrease in serum creatinine with NAC administration, but, given the small sample sizes and clinical heterogeneity, a definitive study should be done to establish the true magnitude and nature of the effect.