Addition of N‐Acetyl Cysteine to Carvedilol Decreases the Incidence of Acute Renal Injury After Cardiac Surgery

Özaydın, Mehmet; Peker, Tülay Tunçer; Akcay, Selahaddin; Uysal, Bayram Ali; Yücel, Habil; Icli, Atilla; Erdoğan, Doğan; Varol, Ercan; Doğan, Abdullah; Okutan, Hüseyin

doi:10.1002/clc.22227

Cited by 11 publications

(9 citation statements)

References 40 publications

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“…The antioxidant action of NAC is mediated by the induction of glutathione synthesis [84]. Data from trials in humans imply that NAC reduces the incidence of AKI after contrast media administration ( p = 0.02) [85], but the direct intravenous administration of glutathione has been shown to be superior as regards renal protection against contrast-induced nephropathy compared to NAC per os [86]. …”

Section: Introductionmentioning

confidence: 99%

Oxidative Stress and Acute Kidney Injury in Critical Illness: Pathophysiologic Mechanisms—Biomarkers—Interventions, and Future Perspectives

Pavlakou

Liakopoulos

Eleftheriadis

et al. 2017

Oxidative Medicine and Cellular Longevity

107

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Acute kidney injury (AKI) is a multifactorial entity that occurs in a variety of clinical settings. Although AKI is not a usual reason for intensive care unit (ICU) admission, it often complicates critically ill patients' clinical course requiring renal replacement therapy progressing sometimes to end-stage renal disease and increasing mortality. The causes of AKI in the group of ICU patients are further complicated from damaged metabolic state, systemic inflammation, sepsis, and hemodynamic dysregulations, leading to an imbalance that generates oxidative stress response. Abundant experimental and to a less extent clinical data support the important role of oxidative stress-related mechanisms in the injury phase of AKI. The purpose of this article is to present the main pathophysiologic mechanisms of AKI in ICU patients focusing on the different aspects of oxidative stress generation, the available evidence of interventional measures for AKI prevention, biomarkers used in a clinical setting, and future perspectives in oxidative stress regulation.

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Section: Introductionmentioning

confidence: 99%

Oxidative Stress and Acute Kidney Injury in Critical Illness: Pathophysiologic Mechanisms—Biomarkers—Interventions, and Future Perspectives

Pavlakou

Liakopoulos

Eleftheriadis

et al. 2017

Oxidative Medicine and Cellular Longevity

107

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“…Plasma creatinine levels in the placebo group at 24 hours after surgery were signi cantly higher than the N-acetylcysteine group. In this study, they found that intravenous administration of NAC in elderly patients undergoing surgery prevents acute kidney damage and improves the results of renal function tests (26) In a meta-analysis study in patients undergoing angiography, concluded that there is a signi cant difference in using N-acetyl cysteine in preventing nephropathy following coronary angiography, and further studies on the use of NAC among high-risk patients are necessary (27).In another study, Ozaidan et al concluded in 2014 that the use of N-acetyl cysteine was effective in reducing the incidence of acute kidney damage following CABG (28). Both of these studies are in line with the results of the present study.…”

Section: Resultsmentioning

confidence: 99%

The effect of N-acetyl cysteine injection on renal function after coronary artery bypass graft surgery : A randomized clinical trial

Javaherforooshzadeh

Shaker

Rashidi

et al. 2021

Preprint

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Objective: This study aimed to compare the effects of N-acetyl cysteine on renal function after coronary artery bypass graft surgery.Method: In this randomized clinical trial conducted in Golestan Hospital, Ahvaz, Iran, 60 candidates for coronary artery bypass graft surgery were selected and divided into two N-acetyl cysteine and control groups (30 people each).Intervention: Patients received 3 (2 intraoperative and 1 postoperative) doses of IV N-acetyl cysteine (100 mg/kg) (n=30) or placebo (n=30) over 24 hour. Prescription times were as follows: after induction of anesthesia, in the Next 4 hours, and in the 16 hours after on. Primary outcomes were serum levels of BUN and Cr, at baseline,4 and 48 hours after surgery. And also need renal replacement therapy (RRT). Secondary outcomes included the hemodynamic variables, Blood products transfusionResults: There were significant differences in BUN between groups at 4 h (P= 0.02) and 48h after surgery (P=0.001) There were significant differences in Cr level between groups at 4 h (P <0.001) and 48h after surgery (P=0.001). MAP at different times (at 4h p=0.002 and 48h after surgery P<0.001) were significantly different between the two groups. There was a significant difference between the two groups in terms of the unit of Packed cell transfusion (P=0.002) and FFP transfusion (P<0.001).Conclusion: In the present study, we found that administration of N-acetyl cysteine can reduce the incidence of acute kidney injury in patients undergoing coronary artery bypass graft surgery and improved kidney functions.Trial registry: IRCT20190506043492N3 Registered at 2020.06.07

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“…[46] In addition to its antioxidant properties, nitric oxide (NO) releasing play a major role in reno-protective effect of carvedilol. [48] Ozaydin et al, [16] observed that, carvedilol synergized the beneficial effect of NAC in preventing AKI that resulted from oxidative stress and inflammation occurring during cardiac surgery in humans, in addition to the decreased incidence of CIN and peak serum creatinine rising after 5 days of procedure. Also, human trials showed promising results of carvedilol in the prevention of CIN, [15,16] and this was confirmed by the results of the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Carvedilol defensive properties over different condition affecting the kidney is well-recognized. [15,16,46] Yasar et al, proved that, carvedilol possessed reno-protective effect in ureteral obstruction in rats by preventing oxidative stress induced by obstruction ischemia. [47] Another study by Akindele et al, showed the same reno-protective effect of carvedilol in preventing nephrotoxicity mediated by oxidative stress of doxorubicin.…”

Section: Discussionmentioning

confidence: 99%

“…[13,14] Carvedilol a member of beta-blockers family was found to have beneficial effect in CIN prevention. [15,16] Theoretically, it has this potential effect to protect from CIN due to its vasodilatory effect on renal blood vessels and its antioxidant activity. [17] Up-to-date, there is no study that evaluated the possible reno-protective effect of combined beta-blocker with statin prior to CC in comparison to short high dose statins.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Combined/Carvedilol Moderate Dose Atorvastatin to Single High Dose Atorvastatin for the Prevention of Contrast-Induced Nephropathy after Cardiac Catheterization

EL-Gazara

Abbassi

Sabry

et al. 2021

Bulletin of Faculty of Pharmacy, Cairo University

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Background: Contrast-induced nephropathy (CIN) is associated with increased morbidity, and the need for short-term hemodialysis. Although several preventive measures have been used, the best approach to prevent CIN is still controversial. Objectives: This study is intended to evaluate the protective effect of carvedilol/ medium dose statin compared to the recommended high dose atorvastatin on the development CIN in patients undergoing elective cardiac catheterization (CC). Patients and Methods: A total of 144 patients planned for CC were randomly assigned to: • Group (A): 49 patients received atorvastatin as single high dose 80 mg 12 hours before CC and another 40 mg of atorvastatin 2 hours before PCI. • Group (B): 48 patients were prescribed carvedilol 12.5 mg twice daily for seven days before CC and continued for 24 hours post CC, plus 40 mg atorvastatin 12 hours before CC. • Group (C): 47 patients received 40 mg atorvastatin 12 hours before CC. Results: The baseline characteristics of the 3 groups were comparable. CIN incidence was the lowest in group A, but was not significantly different (p=0.420). CIN developed in 4(8.2%), 6(12.2%), and 8(17%) patients in groups A, B, and C respectively. Median change in CrCl 48 hours, and serum NGAL 4 hours post CC was significantly lower in group A compared to group C (p=0.0330, p=0.0348 respectively). Conclusion: The present study revealed that, combined carvedilol/statin regimen was comparable to single high dose atorvastatin in CIN prevention. However, short high dose of atorvastatin might be preferable in terms of kidney function preservation.

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Addition of N‐Acetyl Cysteine to Carvedilol Decreases the Incidence of Acute Renal Injury After Cardiac Surgery

Abstract: Combined carvedilol and NAC decreased ARI incidence as compared with carvedilol or metoprolol. No difference was detected between carvedilol and metoprolol.

Cited by 11 publications

References 40 publications

Oxidative Stress and Acute Kidney Injury in Critical Illness: Pathophysiologic Mechanisms—Biomarkers—Interventions, and Future Perspectives

Oxidative Stress and Acute Kidney Injury in Critical Illness: Pathophysiologic Mechanisms—Biomarkers—Interventions, and Future Perspectives

The effect of N-acetyl cysteine injection on renal function after coronary artery bypass graft surgery : A randomized clinical trial

Comparison of Combined/Carvedilol Moderate Dose Atorvastatin to Single High Dose Atorvastatin for the Prevention of Contrast-Induced Nephropathy after Cardiac Catheterization

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