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nephropathy; CKD=chronic kidney disease; N=sample size; NAC=N-acetylcysteine; NaHCO3=sodium bicarbonate; p=p-value; RR=risk ratio 39 Table 6. Summary of the strength of evidence: statins plus IV fluids versus placebo with or without fluids and statins plus Nacetylcysteine versus N-acetylcysteine alone in patients receiving intra-arterial contrast Outcome Study Design: No. Studies (N) Study Limitations Directness Consistency Precision Strength of Evidence Summary of Key Outcomes Development of CIN: statin + IV saline vs. IV saline (meta-analysis) RCT: 8 (5024) Medium Direct Consistent Imprecise Low Low strength of evidence that statins plus IV fluids have a lower risk of CIN than IV fluids aloe. Development of CIN: statin + NAC + IV saline or bicarbonate vs. NAC + IV saline or bicarbonate (meta-analysis)† RCT: 5 (1477) Medium Direct Consistent Imprecise Low Low strength of evidence that statins plus NAC plus IV fluids (or bicarbonate) have a lower risk of CIN than NAC plus IV fluids (or bicarbonate) Need for RRT (statins + IV saline vs. IV saline) RCT 2 (3245) High Direct Consistent Imprecise Insufficient Insufficient strength of evidence that statins plus IV fluids have a lower risk of renal replacement therapy than IV fluids alone. Need for RRT (statin + NAC + IV saline or bicarbonate vs. NAC + IV saline or bicarbonate) RCT: 3 (1017) Medium Direct Consistent Imprecise Insufficient Insufficient strength of evidence that statins plus NAC plus IV fluids (or bicarbonate) have a lower risk of renal replacement therapy than NAC plus IV fluids (or bicarbonate) Mortality (statins + IV saline vs. IV saline) RCT: 1 (2998) High Direct Only 1 study Imprecise Insufficient Insufficient strength of evidence that statins plus IV fluids have a lower risk of mortality than IV fluids alone. Mortality (statin + NAC + IV saline or bicarbonate vs. NAC + IV saline or bicarbonate) RCT: 3 (1017) Medium Direct Consistent Imprecise Insufficient Insufficient strength of evidence that statins plus NAC plus IV fluids (or bicarbonate) have a lower risk of mortality than NAC plus IV fluids (or bicarbonate) Cardiac outcomes (statins + IV saline vs. IV saline) RCT: 1 (2998) High Direct Only 1 study Imprecise Insufficient Insufficient strength of evidence that statins plus IV fluids have a lowers risk of cardiac outcomes than IV fluids alone.

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