BACKGROUND: The renoprotective effect of N-acetylcystein in patients undergoing coronary artery bypass graft surgery is controversial. METHODS: We assessed the renoprotective effect of the highest dose of N-acetylcystein sanctioned for clinical use in a prospective, double-blind, placebo-controlled study including 70 chronic kidney disease patients, stage 3 or 4, who underwent coronary artery bypass graft surgery, on cardiopulmonary bypass (CPB) and off CPB, and were randomly allocated to receive either N-acetylcystein 150 mg/kg followed by 50 mg/kg for 6 hours in 0.9% saline or only 0.9% saline. Acute kidney injury was defined by the Acute Kidney Injury Network classification. RESULTS: The incidence of kidney injury was reduced in the N-acetylcystein group (57.1% versus 28.6%, p=0.016). Nonuse of N-acetylcystein (relative risk 3.58, 95% confidence interval: 1.04 to 12.33, p=0.04) and cardiopulmonary bypass (relative risk 4.55, 95% confidence interval: 1.28 to 16.15, p=0.02) were independent predictors of kidney injury. In patients treated with CPB, N-acetylcystein reduced the incidence of kidney injury from 63% to 46%. Oxidative stress was increased in control subjects (p=0.01) and abolished in patients receiving N-acetylcystein. CONCLUSIONS:Maximum intravenous doses of N-acetylcystein reduce the incidence of acute kidney injury in patients with kidney disease undergoing coronary artery bypass graft surgery, abolish oxidative stress, and mitigate the negative effect of CPB on renal function.
RCT Entities:
BACKGROUND: The renoprotective effect of N-acetylcystein in patients undergoing coronary artery bypass graft surgery is controversial. METHODS: We assessed the renoprotective effect of the highest dose of N-acetylcystein sanctioned for clinical use in a prospective, double-blind, placebo-controlled study including 70 chronic kidney diseasepatients, stage 3 or 4, who underwent coronary artery bypass graft surgery, on cardiopulmonary bypass (CPB) and off CPB, and were randomly allocated to receive either N-acetylcystein 150 mg/kg followed by 50 mg/kg for 6 hours in 0.9% saline or only 0.9% saline. Acute kidney injury was defined by the Acute Kidney Injury Network classification. RESULTS: The incidence of kidney injury was reduced in the N-acetylcystein group (57.1% versus 28.6%, p=0.016). Nonuse of N-acetylcystein (relative risk 3.58, 95% confidence interval: 1.04 to 12.33, p=0.04) and cardiopulmonary bypass (relative risk 4.55, 95% confidence interval: 1.28 to 16.15, p=0.02) were independent predictors of kidney injury. In patients treated with CPB, N-acetylcystein reduced the incidence of kidney injury from 63% to 46%. Oxidative stress was increased in control subjects (p=0.01) and abolished in patients receiving N-acetylcystein. CONCLUSIONS: Maximum intravenous doses of N-acetylcystein reduce the incidence of acute kidney injury in patients with kidney disease undergoing coronary artery bypass graft surgery, abolish oxidative stress, and mitigate the negative effect of CPB on renal function.
Authors: David M Small; Washington Y Sanchez; Sandrine F Roy; Christudas Morais; Heddwen L Brooks; Jeff S Coombes; David W Johnson; Glenda C Gobe Journal: Am J Physiol Renal Physiol Date: 2018-01-10
Authors: Mehmet Oezkur; Attila Magyar; Phillip Thomas; Andreas Reif; Stefan Störk; Peter U Heuschmann; Rainer G Leyh; Martin Wagner Journal: BMC Nephrol Date: 2018-02-09 Impact factor: 2.388
Authors: José Eduardo G Pereira; Regina El Dib; Leandro G Braz; Janaina Escudero; Jason Hayes; Bradley C Johnston Journal: PLoS One Date: 2019-05-09 Impact factor: 3.240
Authors: Eduesley Santana-Santos; Felipe Kenji Oshiro Kamei; Tarcísia Karoline do Nascimento; Anas Abou Ismail; Jurema da Silva Herbas Palomo; Marcia Cristina da Silva Magro; Fátima Gil Ferreira; Larissa Bertacchini de Oliveira; Adriano Rogério Baldacin Rodrigues; José Jayme Galvão de Lima Journal: Int J Nephrol Date: 2016-06-30