Original articleAdult cardiacHigh Dose of N-Acetylcystein Prevents Acute Kidney Injury in Chronic Kidney Disease Patients Undergoing Myocardial Revascularization
Section snippets
Study Protocol
This study is registered for clinical trials (clinicaltrials.gov NCT01359722). The Institutional Ethics Board approved the study; participants signed a written informed consent.
Patients with estimated glomerular filtration rate of 15 or greater and less than 60 mL · min−1 · 1.73 m−2 [19], scheduled to undergo elective CABG from January 2, 2009, to November 15, 2012, were considered for inclusion. There were eligible 231 patients; 161 were excluded for the following reasons: dialysis (n = 22);
Preoperative Characteristics
Table 1 shows the preoperative characteristics. The proportion of males was greater in the control group (86% versus 57%, p = 0.02) whereas the left ventricular ejection fraction tended to be higher in the NAC group (p = 0.052). In all other aspects, the groups were well balanced. Creatinine, glomerular filtration rate (control, 44.7 ± 12; NAC, 45.9 ± 9.2; p = 0.64) as well as lipids, urea, and glucose were similar in both groups.
Perioperative Characteristics
We found no differences between groups in intraoperative
Comment
In this study, we showed that maximum doses of NAC sanctioned for human use reduced the incidence of AKI among patients with moderate chronic kidney disease undergoing elective CABG. The nonuse of NAC was an independent predictor of AKI (RR 3.58, p = 0.04) together with CPB (RR 4.55, p = 0.02). The data suggest that the nonuse of NAC and CPB interact to increase the probability of AKI and that NAC attenuates the negative effects of CPB on renal function. To our knowledge, this is the first
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Cited by (30)
Small molecules as a source for acute kidney injury therapy
2022, Pharmacology and TherapeuticsCitation Excerpt :N-acetylcysteine, an antioxidant, has been thoroughly assessed for its renoprotective efficiency in many clinical trials. N-acetylcysteine alleviated oxidative stress and reduced AKI incidence in patients with kidney disease undergoing coronary artery bypass graft surgery (NCT01359722, Table 2 and Fig. 1) (Santana-Santos et al., 2014). In addition, N-acetylcysteine alleviated AKI in patients with coronary artery bypass graft surgery (IRCT20190506043492N3, Table 2), patients treated with vancomycin and ifosfamide, and patients with renal dysfunction exposed to contrast media (Badri et al., 2020; Hanly et al., 2012; Heguilén et al., 2013; Javaherforooshzadeh, Shaker, Rashidi, Akhondzadeh, & Hayati, 2021).
Antioxidants and kidney diseases
2022, Antioxidants Effects in Health: The Bright and the Dark SideUnraveling the in vitro antitumor activity of Vismia baccifera against HepG2: role of hydrogen peroxide
2018, HeliyonCitation Excerpt :Inside the cell, it is readily deacetylated to yield L-cysteine, functioning as a GSH precursor. NAC has also been applied in vivo to diseases associated with oxidative stress [29] and against cancer, acting as adjuvant that reduces the chemotherapy-related toxicity [30]. In our system, NAC was unable to protect cells against toxicity, despite it prevented GSH depletion.
Kidney and Endothelium
2018, Endothelium and Cardiovascular Diseases: Vascular Biology and Clinical SyndromesProtective effect of N-acetylcysteine on progression to end-stage renal disease: Necessity for prospective clinical trial
2017, European Journal of Internal MedicineCitation Excerpt :These cellular events are involved in the development and progression of maladaptive myocardial remodeling and failure [30]. Although a high dose of NAC has been confirmed to prevent acute kidney injury in CKD patients undergoing heart surgery, the renal protective effect in non-surgery-related heart failure remains to be elucidated [31]. As with most retrospective studies, there were strengths and limitations in our study.
Renoprotective Effect of Highdose N-Acetylcysteine in Patients Who Underwent Cardiac Surgery: an observational study
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