 |
 |

Acetylcysteine in the Prevention of Contrast-Induced Nephropathy
A Case Study of the Pitfalls in the Evolution of Evidence
Sean M. Bagshaw, MD, MSc;
Finlay A. McAlister, MD, MSc;
Braden J. Manns, MD, MSc;
William A. Ghali, MD, MPH
Arch Intern Med. 2006;166:161-166.
During the past 5 years, 19 randomized controlled trials, 4 prospective nonrandomized studies, and 11 meta-analyses that explored the role of acetylcysteine for prevention of contrast-induced nephropathy have been published. Herein, we summarize this literature and demonstrate that these 34 empirical studies have not yet conclusively resolved this research question. We use the evidence on acetylcysteine as a case study of how research evidence accumulates and consider whether an alternative approach to investigating the question of acetylcysteine's efficacy could have resulted in a more definitive conclusion. We consider the broader lessons learned from this acetylcysteine case study for the medical and research communities and propose specific steps that could be taken to improve the future coordination of research activity to ultimately yield more meaningful and definitive evidence on important clinical questions.
Author Affiliations: Departments of Critical Care Medicine (Dr Bagshaw), Medicine (Drs Manns and Ghali), and Community Health Sciences (Dr Bagshaw), and the Center for Health and Policy Studies (Drs Manns and Ghali), University of Calgary, Calgary, Alberta; and Department of Medicine, University of Alberta, Alberta, Edmonton (Dr McAlister).
CiteULike Connotea Del.icio.us Digg Reddit Technorati
What's this?
RELATED LETTERS
From Chaotic to Coordinated Clinical Research: The Case of Acetylcysteine
Giuseppe G. L. Biondi-Zoccai, Antonio Abbate, Marco Valgimigli, Luca Testa, and Pierfrancesco Agostoni
Arch Intern Med. 2006;166(15):1668.
EXTRACT
| FULL TEXT
N-acetylcysteine for Contrast Nephropathy: More Clinical Science Is Required
Michael Eddleston, Jane Goddard, and Nick Bateman
Arch Intern Med. 2006;166(15):1668-1669.
EXTRACT
| FULL TEXT
N-acetylcysteine for Contrast Nephropathy: More Clinical Science Is RequiredReply
Sean M. Bagshaw, Finlay A. McAlister, Braden J. Manns, and William A. Ghali
Arch Intern Med. 2006;166(15):1669.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
 |
Reducing the Risk of Contrast-Induced Nephropathy: A Perspective on the Controversies
Ellis and Cohan
Am. J. Roentgenol. 2009;192:1544-1549.
ABSTRACT
| FULL TEXT
Efficacy of N-acetylcysteine in preventing renal injury after heart surgery: a systematic review of randomized trials
Adabag et al.
Eur Heart J 2009;0:ehp053v1-8.
ABSTRACT
| FULL TEXT
Nephrotoxicity of Iso-osmolar Iodixanol Compared with Nonionic Low-osmolar Contrast Media: Meta-analysis of Randomized Controlled Trials
Heinrich et al.
Radiology 2009;250:68-86.
ABSTRACT
| FULL TEXT
Building upon existing evidence to shape future research endeavors
Smith
Am J Health Syst Pharm 2008;65:1767-1774.
ABSTRACT
| FULL TEXT
Evaluation and Initial Management of Acute Kidney Injury
Himmelfarb et al.
CJASN 2008;3:962-967.
ABSTRACT
| FULL TEXT
Improved estimation of glomerular filtration rate by serum cystatin C in preventing contrast induced nephropathy by N-acetylcysteine or zinc--preliminary results
Kimmel et al.
Nephrol Dial Transplant 2008;23:1241-1245.
ABSTRACT
| FULL TEXT
Sodium Bicarbonate is Associated with an Increased Incidence of Contrast Nephropathy: A Retrospective Cohort Study of 7977 Patients at Mayo Clinic
From et al.
CJASN 2008;3:10-18.
ABSTRACT
| FULL TEXT
N-Acetylcysteine in the Prevention of Contrast-Induced Nephropathy
Fishbane
CJASN 2008;3:281-287.
ABSTRACT
| FULL TEXT
N-acetylcysteine to ameliorate acute renal injury in a rat cardiopulmonary bypass model
Zhu et al.
J. Thorac. Cardiovasc. Surg. 2007;133:696-703.
ABSTRACT
| FULL TEXT
From Chaotic to Coordinated Clinical Research: The Case of Acetylcysteine.
Biondi-Zoccai et al.
Arch Intern Med 2006;166:1668-1668.
FULL TEXT
N-acetylcysteine for Contrast Nephropathy: More Clinical Science Is Required--Reply
Bagshaw et al.
Arch Intern Med 2006;166:1669-1669.
FULL TEXT
N-acetylcysteine for Contrast Nephropathy: More Clinical Science Is Required.
Eddleston et al.
Arch Intern Med 2006;166:1668-1669.
FULL TEXT
|