Contrast-induced nephropathy
Supplements studied for contrast-induced nephropathy.
Overview
N-Acetyl Cysteine (NAC) dominates contrast-induced nephropathy research here, with 17 indexed studies. Oral or IV NAC may protect kidneys from contrast dye injury in people with reduced kidney function, often outperforming hydration alone and possibly adding benefit when combined with statins.
NAC may not help people with normal kidney function. Quercetin 500 mg every eight hours around cardiac imaging did not lower nephropathy risk in one small study. See the heatmap and evidence reviews below for population and protocol detail.
Effect graph
Relevant supplements
Relevant supplements sorted by DEX Score.
| N-Acetyl Cysteine (NAC) | ★★★★★ | Very Low / None |
| Quercetin | ★★★★★ | Low |
| Milk Thistle | ★★★★★ | Very Low / None |
Studies
Find individual evidence reviews for supplements sorted by DEX Score.
3 supplements for and rated at least stars. All purchase bands. No minimum star filter.
N-Acetyl Cysteine (NAC)View supplement →
Reconsider purchase·★★★★★
How we scored this▸
- N-acetylcysteine, taken by mouth or intravenously, helps protect the kidneys from damage caused by contrast dye in people with reduced kidney function.
- It works better than hydration alone and may be even more effective when combined with certain medicines like statins.
- However, it doesn’t help people with normal kidney function or people with diabetes.
Browse 17 studies·4 meta-analyses
MetaMeta-analytic Techniques to Assess the Association Between N-acetylcysteine and Acute Kidney Injury After Contrast Administration: A Systematic Review and Meta-analysis2022
A meta-analysis found NAC was associated with reduced contrast-induced nephropathy risk in patients undergoing angiography.
- Effect
- Benefit
- Population
- Adults
RCTComparison of Oral and Intravenous N-acetyl Cysteine in Preventing Contrast Nephropathy2020n=434
An RCT of 434 patients found oral and IV NAC were similarly effective for preventing contrast-induced nephropathy after angiography.
- Effect
- No Benefit
- Duration
- 3 days
- Dose
- 600 mg 2×/day
- Population
- Adults
- Participants
- 434
MetaComparative Effectiveness of 12 Treatment Strategies for Preventing Contrast-Induced Acute Kidney Injury: A Systematic Review and Bayesian Network Meta-analysis2017n=31,631
A comparative effectiveness meta-analysis of 31,631 patients ranked NAC among effective strategies for preventing contrast-induced nephropathy.
- Effect
- Benefit
- Population
- Adults undergoing contrast procedures
- Participants
- 31,631
MetaPreventive Strategies for Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Procedures: Evidence From a Hierarchical Bayesian Network Meta-Analysis of 124 Trials and 28 240 Patients2017n=240
A meta-analysis found NAC plus hydration significantly reduced contrast-induced acute kidney injury risk in patients undergoing cardiac catheterization.
- Effect
- No Benefit
- Population
- Diabetic patients
- Participants
- 240
RCTEfficacy of ascorbic acid, N-acetylcysteine, or combination of both on top of saline hydration versus saline hydration alone on prevention of contrast-Induced nephropathy: a prospective randomized study2013n=243
An RCT of 243 patients found NAC plus ascorbic acid on top of saline hydration reduced contrast-induced nephropathy versus saline alone.
- Effect
- No Benefit
- Duration
- 4–5 days
- Dose
- 4 g/day
- Population
- Adults at risk of contrast-induced nephropathy
- Participants
- 243
RCTUsefulness of N-acetylcysteine or ascorbic acid versus placebo to prevent contrast-induced acute kidney injury in patients undergoing elective cardiac catheterization: a single-center, prospective, randomized, double-blind, placebo-controlled trial2013n=520
An RCT of 520 patients found neither NAC nor ascorbic acid added significant benefit to standard hydration for preventing contrast nephropathy.
- Effect
- No Benefit
- Dose
- 500 mg/day
- Population
- Adults with chronic renal insufficiency
- Participants
- 520
RCTN-acetylcysteine versus Ascorbic acid for preventing contrast-Induced nephropathy in patients with renal insufficiency undergoing coronary angiography (NASPI study) – a prospective randomized controlled trial2009n=212
An RCT of 212 patients found NAC was comparable to ascorbic acid for preventing contrast-induced nephropathy during angiography.
- Effect
- Benefit
- Dose
- 200 mg 2×/day
- Population
- Diabetic patients
- Participants
- 212
RCTIs treatment with N-acetylcysteine to prevent contrast-induced nephropathy when using bicarbonate hydration out of date?2008n=32
An RCT found NAC prophylaxis did not significantly prevent contrast-induced nephropathy when added to adequate hydration in low-risk patients.
- Effect
- No Benefit
- Dose
- 200 mg/day
- Population
- Adults with chronic renal failure
- Participants
- 32
RCTPredictors for contrast media-induced nephropathy and long-term survival: prospectively assessed data from the randomized controlled Dialysis-Versus-Diuresis (DVD) trial2008
A prospective study identified baseline renal function and contrast volume as stronger predictors of contrast nephropathy than NAC prophylaxis alone.
- Population
- Adults undergoing coronary angiography
MetaA meta-analysis of N-acetylcysteine in contrast-induced nephrotoxicity: unsupervised clustering to resolve heterogeneity2007n=18
An unsupervised meta-analysis found NAC significantly reduced contrast-induced nephrotoxicity, though trial quality varied widely.
- Effect
- No Benefit
- Population
- Patients undergoing contrast procedures
- Participants
- 18
RCTA randomized controlled trial comparing hydration therapy to additional hemodialysis or N-acetylcysteine for the prevention of contrast medium-induced nephropathy: the Dialysis-versus-Diuresis (DVD) Trial2007
An RCT found additional hemodialysis after contrast exposure did not outperform hydration plus NAC for preventing nephropathy in CKD patients.
- Effect
- Benefit
- Duration
- 30–60 days
- Dose
- 1.3–3.5 mg/day
- Population
- ALL patients
RCTEvidence-based emergency medicine review: Prevention of contrast-induced nephropathy in the emergency department2007
An evidence review concluded NAC with hydration may reduce contrast-induced nephropathy risk, but trial results remain inconsistent.
- Effect
- No Benefit
- Population
- Patients with baseline renal insufficiency
RCTPrevention of contrast-induced nephropathy in vascular surgery patients2007
An RCT in vascular surgery patients found NAC plus hydration did not significantly reduce contrast-induced nephropathy versus hydration alone.
- Effect
- No Benefit
- Population
- Vascular surgery patients
RCTAcetylcysteine In Diabetes (AID): a randomized study of acetylcysteine for the prevention of contrast nephropathy in diabetics2006n=69
The AID trial found NAC (600 mg twice daily) significantly reduced contrast-induced nephropathy in diabetic patients undergoing angiography.
- Effect
- No Benefit
- Dose
- 600 mg 2×/day
- Population
- Diabetic patients
- Participants
- 69
- Avg age
- ~65
RCTComparison of N-acetylcysteine and fenoldopam for preventing contrast-induced nephropathy (CAFCIN)2006
An RCT found NAC (600 mg twice daily) was comparable to fenoldopam for preventing contrast-induced nephropathy after angiography.
- Effect
- No Benefit
- Dose
- 600 mg 2×/day
- Population
- Adults
- Avg age
- ~68
RCTDoes N-acetylcysteine prevent contrast-induced nephropathy during endovascular AAA repair? A randomized controlled pilot study2006
An RCT found NAC did not significantly prevent contrast-induced nephropathy during endovascular AAA repair versus hydration alone.
- Effect
- No Benefit
- Dose
- 600 mg 2×/day
- Population
- Men
- Avg age
- ~72
RCTAcetylcysteine in the prevention of contrast-induced nephropathy after coronary angiography2003
An RCT found IV NAC (1500 mg/day) before coronary angiography significantly reduced contrast-induced nephropathy versus hydration alone.
- Effect
- No Benefit
- Dose
- 1500 mg/day
- Population
- Diabetic patients
QuercetinView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- It is not clear if taking quercetin by mouth helps prevent kidney damage caused by contrast dye used in some heart imaging tests.
- A small study showed that taking 500 mg of quercetin every 8 hours starting two days before the test and continuing for two days after did not lower the risk compared to no quercetin.
- The study was small, so more research is needed.
Browse 1 study
Clinical trialQuercetin, a Promising Clinical Candidate for The Prevention of Contrast-Induced Nephropathy2019n=50
In prediabetic/cath lab patients, quercetin pretreatment for 3–5 days reduced contrast-induced nephropathy incidence and protected glomerular filtration versus contrast media alone.
- Effect
- Benefit
- Duration
- 3–5 days
- Dose
- 1500 mg/day
- Population
- Patients undergoing coronary catheterization
- Participants
- 50
- Ages
- 18+
Milk ThistleView supplement →
Do not purchase·★★★★★
How we scored this▸
- It is uncertain if milk thistle can protect the kidneys from damage caused by contrast dyes used in some medical imaging tests.
- One study in people with liver cirrhosis found that taking milk thistle daily for at least 3 months did not lower the risk of kidney problems from contrast agents over the following years.
- Some early research suggests milk thistle might help protect the kidneys, but more studies are needed to confirm this.
Browse 1 study
ObservationalEvaluation of nephroprotection of silymarin on contrast-induced nephropathy in liver cirrhosis patients: A population-based cohort study2018n=3,019
A cohort study of 3,019 liver cirrhosis patients found silymarin use was not associated with reduced risk of contrast-induced nephropathy vs nonusers.
- Effect
- No Benefit
- Population
- Patients with liver cirrhosis
- Participants
- 3,019
Evidence visualised
Same ratings as above, aggregated so you can see coverage and imbalance.
| Supplement | DEX | Studies | Meta-analyses | Share |
|---|---|---|---|---|
| N-Acetyl Cysteine (NAC) | ★★★★★44% | 17 | 4 | 89% |
| Milk Thistle | ★★★★★28% | 1 | 0 | 5% |
| Quercetin | ★★★★★40% | 1 | 0 | 5% |