N-Acetylcysteine does not prevent renal dysfunction after off-pump coronary artery bypass surgery

Prasad, Apoorva; Banakal, Sanjaykumar; Kanchi, Muralidhar

doi:10.1097/eja.0b013e3283383506

Cited by 14 publications

(15 citation statements)

References 28 publications

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“…Moreover, in this study, patients treated with N‐acetylcysteine were less likely to require mechanical ventilation for a prolonged (>48 hours) period (3% vs 18%; P < .001) and to have a stay in the intensive care unit of longer than 4 days (13% vs 33%; P < .001), suggesting a positive effect of N‐acetylcysteine on CPB‐induced ischemia‐reperfusion renal and pulmonary injuries and, as a result, on the overall clinical course of the patients. On the other hand, no protection against AKI was offered by N‐acetylcysteine in patients undergoing off‐pump cardiac surgery in this study, as well as in a recent study by Prasad et al 29 It is possible that these results reflect the counteracting action of N‐acetylcysteine on oxidative stress, reperfusion injury, and systemic inflammatory response associated with CPB. Indeed, severe oxidative stress was demonstrated to occur from the extracorporeal circulation of blood, 37 blood cardioplegia, and reperfusion injury 38 .…”

Section: Discussioncontrasting

confidence: 68%

“…Notably, when only patients undergoing cardiac surgery with CPB support were considered (90% of the whole study population), N‐acetylcysteine‐treated patients showed a significantly lower incidence of AKI than controls (40% vs 54%; P = .03). Conversely, no beneficial effect of N‐acetylcysteine on renal function was observed in a recent study by Prasad et al, 29 in which only high‐risk patients undergoing off‐pump CABG were considered.…”

Section: Resultsmentioning

confidence: 92%

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N-Acetylcysteine for the Prevention of Acute Kidney Injury After Cardiac Surgery

Sisillo

Marenzi

2011

The Journal of Clinical Pharmacology

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A cute kidney injury (AKI) is a serious complication after cardiac surgery and is associated with increased short-term and long-term mortality. 1,2 This complication occurs in 5%-30% of patients who undergo cardiac surgery, depending on the definition used for AKI. Most of the previous studies focused on severe AKI, defined either as need for dialysis or substantial increase in serum creatinine. 1 However, studies reporting an association between small changes in serum creatinine and adverse short-term outcome are emerging in the literature. 2,3 It was reported that in 6%-20% of patients who develop AKI, dialysis is required and that 12%-64% of these patients die, compared with 1%-5% of those without AKI. 4-7 The mortality risk after cardiac surgery increases with even minor elevations of creatinine from baseline and may exceed 50% in the most severe cases that require hemodialysis. 8 Acute renal dysfunction also has an important impact on nonrenal morbidity. Indeed, patients who develop AKI after cardiac surgery have higher incidence of gastrointestinal bleeding, respiratory failure, infections, and sepsis. 9,10 Several risk factors for postoperative AKI have been identified. The most consistent are preexisting chronic kidney disease (CKD), advanced age, history of heart failure, diabetes mellitus, prolonged cardiopulmonary bypass (CPB) time, and recent exposure to nephrotoxic agents, such as contrast dye. 4,11-13 In patients with moderate and severe CKD, as defined by an estimated creatinine clearance lower than 60 mL/min, postoperative AKI occurs in almost 50% of patients and is associated with a rate of perioperative mortality that is 10 times higher, increasing to up to more than 30 times higher for patients requiring renal replacement therapy. 13 Many factors contribute to post-cardiac surgery AKI, including exogenous toxins; hemodynamic and metabolic factors; inflammation; neurohormonal activation; release of vasoconstrictor compounds, induced by CPB; and the interactions between blood components and artificial membranes. 14 All these mechanisms may contribute to vasoconstriction and renal ischemia and result in formation of oxygen free radicals. In particular, use of CPB during cardiac surgery, and systemic exposure to these nonbiologic surfaces, liberate oxygen free radicals from activated neutrophils, provoking an oxidative stress response that can activate systemic inflammatory processes. 15-17 Moreover, CPB has been shown to increase renal vascular resistance and to release emboli. 4,18-20 The use of CPB can also increase serum substances, including total peroxide, reactive oxidative metabolites, C reactive protein, and interleukin-6. 16,21,22 Thus, agents with antioxidant properties may attenuate the oxidative stress and resultant inflammation observed in patients undergoing cardiac surgery and may potentially reduce postoperative complications. 17,[23][24][25] As high-risk patients can be easily identified before cardiac surgery, implementation of prophylactic measures represents the best opportunit...

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Section: Discussioncontrasting

confidence: 68%

Section: Resultsmentioning

confidence: 92%

N-Acetylcysteine for the Prevention of Acute Kidney Injury After Cardiac Surgery

Sisillo

Marenzi

2011

The Journal of Clinical Pharmacology

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“…We conducted a detailed evaluation of the complete report for 236 trials proceeded to a detailed evaluation of the complete report, following which a further 175 articles were excluded. Finally, the 61 remaining articles were included in our meta‐analysis . A flowchart describing the article selection process for this meta‐analysis is shown in Figure .…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of N ‐Acetylcysteine for the Prevention of Contrast‐Induced Nephropathy: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Tao

Bai

et al. 2016

JAHA

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BackgroundConflicting results have been obtained in trials that have evaluated the prophylactic efficacy of N‐acetylcysteine (NAC) pretreatment in the prevention of contrast‐induced nephropathy (CIN). In this meta‐analysis of randomized controlled trials, we aimed to assess the effectiveness of NAC treatment for the prevention of CIN.Methods and ResultsPubMed, EMBASE, and the Cochrane Library were electronically searched from inception to January 2016 for all relevant studies. The weighted relative risk (RR) and corresponding 95% CI for incident CIN were estimated using random effects models. Standard methods for assessing statistical heterogeneity and publication bias were used. The study included 11 480 participants and 1653 cases of CIN. The incidence of CIN was 12.8% in the NAC group versus 16.0% in the control group (RR: 0.76, 95% CI: 0.66–0.88, P=0.0002). In the patients undergoing coronary angiography, the incidence of CIN in the NAC group versus the control group was 13.7% versus 17.2% (RR: 0.74, 95% CI: 0.63–0.87, P=0.0002); in those undergoing peripheral angiography, the incidence was 6.4% versus 5.8% (RR: 1.00, 95% CI: 0.42–2.40, P=1.00); in those undergoing computed tomography, the incidence was 7.7% versus 14.8% (RR: 0.51, 95% CI: 0.29–0.89, P=0.02).ConclusionsOur meta‐analysis showed an inverse and significant association between NAC supplementation and risk of CIN in patients undergoing coronary angiography and computed tomography, while a protective role for NAC in patients undergoing peripheral angiography was not obvious.

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“…By far, only one clinical trial has evaluated the effect of NAC on prevention of renal dysfunction after OPCAB, which could not demonstrate any beneficial influence. 19 In that study, however, the dose of NAC was relatively low; 1200 mg a day from preoperative day until the second postoperative day. It was suggested that the effect of NAC as an antioxidant was dose dependent and high dose of NAC could fully demonstrate its effect.…”

Section: Discussionmentioning

confidence: 99%

Double‐blinded, randomized controlled trial of N‐acetylcysteine for prevention of acute kidney injury in high risk patients undergoing off‐pump coronary artery bypass

et al. 2015

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N-Acetylcysteine does not prevent renal dysfunction after off-pump coronary artery bypass surgery

Abstract: N-Acetylcysteine does not have any beneficial effect on renal function in high-risk patients undergoing off-pump coronary artery bypass graft.

Cited by 14 publications

References 28 publications

N-Acetylcysteine for the Prevention of Acute Kidney Injury After Cardiac Surgery

N-Acetylcysteine for the Prevention of Acute Kidney Injury After Cardiac Surgery

Effectiveness of N ‐Acetylcysteine for the Prevention of Contrast‐Induced Nephropathy: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Double‐blinded, randomized controlled trial of N‐acetylcysteine for prevention of acute kidney injury in high risk patients undergoing off‐pump coronary artery bypass

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