Huang Johnny W, Clarkin Owen J, McCudden Christopher, Akbari Ayub, Chow Benjamin J W, Shabana Wael, Kanji Salmaan, Davis Alexandra, Hiremath Swapnil
The Ottawa Hospital, University of Ottawa, ON, Canada.
University of Ottawa Heart Institute, ON, Canada.
Can J Kidney Health Dis. 2018 Sep 24;5:2054358118801017. doi: 10.1177/2054358118801017. eCollection 2018.
N-acetylcysteine (NAC) is an antioxidant which can regenerate glutathione and is primarily used for acetaminophen overdose. It is also a potential therapy to prevent iatrogenic acute kidney injury or slow the progression of chronic kidney disease. It has been considered in this context by many studies with mixed results. Notably, a biological-mechanism rationale for a protective effect of NAC has never been adequately reported. Among conflicting reports, there appears to be evidence that NAC may artificially lower measured serum creatinine without improving kidney function, potentially by assay interference. Given these mixed results, a systematic review of the literature will be conducted to determine whether there is an effect of NAC on kidney function measured with serum creatinine.
To determine the effect of NAC on kidney function.
A systematic review and meta-analysis.
Prospective studies, with administration of NAC, in the absence of any other change in kidney function (such as contrast administration or surgery).
Adult humans aged 18 years old or more, either healthy volunteers or with chronic kidney disease, were administered with NAC. Populations having little to no kidney function such as in end-stage kidney disease will be excluded.
Serum creatinine and/or cystatin C measurements before and after NAC administration.
An information specialist will assist in searching MEDLINE, EMBASE, and the Cochrane CENTRAL databases to identify all study types including randomized controlled trials, and prospective cohort studies reporting change in serum creatinine after NAC administration. Two reviewers will independently screen the titles and abstracts of the studies obtained from the search using predefined inclusion criteria and will then extract data from the full texts of selected studies. The weighted mean difference will be calculated for change in creatinine with NAC, using random-effects analysis. Quality assessment will be done with the Cochrane Risk of Bias tool for randomized trials and the Newcastle-Ottawa Scale for observational studies.
The outcome of interest is kidney function as reported by either change in serum creatinine and/or serum cystatin C measurement for randomized trials or comparing baseline (pre-NAC dose) values and those following the NAC dose.
Possible heterogeneity and publication bias and lack of mechanistic data.
This systematic review will provide a synthesis of current evidence on the effect of NAC on serum creatinine measurement. These findings will provide clinicians with guidelines and serve as a strong research base for future studies in this field.
This review is registered with PROSPERO, CRD42017055984.
N-乙酰半胱氨酸（NAC）是一种抗氧化剂，可使谷胱甘肽再生，主要用于对乙酰氨基酚过量中毒。它也是预防医源性急性肾损伤或减缓慢性肾病进展的一种潜在疗法。许多研究在这方面对其进行了探讨，但结果不一。值得注意的是，NAC具有保护作用的生物学机制原理从未得到充分报道。在相互矛盾的报告中，似乎有证据表明NAC可能会人为降低测得的血清肌酐水平，而不改善肾功能，这可能是由于检测干扰所致。鉴于这些结果不一，将对文献进行系统综述，以确定NAC对血清肌酐所测得的肾功能是否有影响。
确定NAC对肾功能的影响。
系统综述和荟萃分析。
在肾功能无任何其他变化（如使用造影剂或进行手术）的情况下，对NAC给药进行前瞻性研究。
18岁及以上的成年人，包括健康志愿者或慢性肾病患者，接受NAC治疗。几乎没有肾功能的人群，如终末期肾病患者将被排除。
NAC给药前后的血清肌酐和/或胱抑素C测量值。
一名信息专家将协助检索MEDLINE、EMBASE和Cochrane CENTRAL数据库，以识别所有研究类型，包括随机对照试验和前瞻性队列研究，这些研究报告了NAC给药后血清肌酐的变化。两名评审员将使用预定义的纳入标准独立筛选从搜索中获得的研究的标题和摘要，然后从选定研究的全文中提取数据。将使用随机效应分析计算NAC治疗后肌酐变化的加权平均差。将使用Cochrane偏倚风险工具对随机试验进行质量评估，并使用纽卡斯尔-渥太华量表对观察性研究进行质量评估。
感兴趣的结果是随机试验中血清肌酐和/或血清胱抑素C测量值的变化所报告的肾功能，或比较基线（NAC给药前剂量）值和NAC给药后的值。
可能存在异质性和发表偏倚，且缺乏机制数据。
本系统综述将综合当前关于NAC对血清肌酐测量影响的证据。这些发现将为临床医生提供指导，并为该领域未来的研究提供有力的研究基础。
本综述已在PROSPERO注册，注册号为CRD42017055984。
