N-acetylcysteine for preventing acute kidney injury in cardiac surgery patients with pre-existing moderate renal insufficiency

Wijeysundera, Duminda N.; Beattie, W. Scott; Rao, Vivek; Granton, John; Chan, Christopher T.

doi:10.1007/bf03026790

Cited by 66 publications

(68 citation statements)

References 48 publications

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“…In addition, because patients with kidney dysfunction are at increased risk for adverse cardiovascular outcomes after major surgery they may benefit from aggressive treatment of atherosclerotic risk factors and potentially the targeted use of therapeutic interventions such as statin therapy. 78 Similarly, interventions such as N-acetyl cysteine 79 might potentially be used to prevent renal injury. In conclusion, we have found that kidney function, defined using eGFR, predicts cardiovascular events and AKI after, predominantly cardiac and vascular, surgery and, in particular, exhibits a powerful inverse nonlinear relationship with all-cause mortality in this setting.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Estimates of Glomerular Filtration Rate as Predictors of Outcome after Surgery

et al. 2013

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Background: Kidney dysfunction is a strong determinant of prognosis in many settings. Methods: A systematic review and meta-analysis was undertaken to explore the relationship between estimated glomerular filtration rate (eGFR) and adverse outcomes after surgery. Cohort studies reporting the relationship between eGFR and major outcomes, including all-cause mortality, major adverse cardiovascular events, and acute kidney injury after cardiac or noncardiac surgery, were included. Results: Forty-six studies were included, of which 44 focused exclusively on cardiac and vascular surgery. Within 30 days of surgery, eGFR less than 60 ml·min·1.73 m −2 was This article has been selected for the ANESTHESIOLOGY CME Program. Learning objectives and disclosure and ordering information can be found in the CME section at the front of this issue. ABSTRACTThe use of ultrasound guidance has provided an opportunity to perform many peripheral nerve blocks that would have been difficult to perform in children based on pure landmark techniques due to the potential for injection into contiguous sensitive vascular areas. This review article provides the readers with techniques on ultrasoundguided peripheral nerve blocks of the extremities and trunk with currently available literature to substantiate the available evidence for the use of these techniques. Ultrasound images of the blocks with corresponding line diagrams to demonstrate the placement of the ultrasound probe have been provided for all the relevant nerve blocks in children. The authors hope that this review will stimulate further research into ultrasound-guided regional anesthesia in infants, children, and adolescents and stimulate more randomized controlled trials to provide a greater understanding of the anatomy and physiology of regional anesthesia in pediatrics.

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Section: Discussionmentioning

confidence: 99%

Preoperative Estimates of Glomerular Filtration Rate as Predictors of Outcome after Surgery

et al. 2013

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“…Moreover, Wijeysundera et al [11] found that there was preservation of postoperative eGFR in patients with preexisting moderate renal dysfunction undergoing cardiac surgery and a significant reduction in mortality with NAC. In our study, we observed increased creatinine clearance and augmented eGFR.…”

Section: Discussionmentioning

confidence: 99%

N-acetylcysteine Versus Dopamine to Prevent Acute Kidney Injury After Cardiac Surgery In Patients with Pre-existing Moderate Renal Insufficiency

Şavluk

Güzelmeriç

Yavuz

et al. 2015

Journal of Cardiothoracic and Vascular Anesthesia

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Objective: Acute kidney injury after cardiac surgery is associated with mortality and morbidity. Therefore, strategies to prevent acute kidney injury are very important. The aim of this placebo-controlled randomized double-blind study was to compare the prophylactic efficacy of N-Acetylcysteine and dopamine administration in patients with pre-existing moderate renal insufficiency who were undergoing cardiopulmonary bypass.Methods: This study included 135 patients with pre-existing moderate renal insufficiency who were scheduled for coronary artery bypass grafting surgery. Serum creatinine and GFR were recorded preoperatively and on the first and second postoperative days.Results: On the first and second postoperative days, the drugs used showed statistically significant differences among the creatinine groups (P<0.001). According to Tukey's HSD, on the first and second PO, the creatinine of Group N, D and P were significantly different (P<0.001). On the first and second PO, the used drugs showed statistically significant differences among the effects of eGFR (P<0.001). According to Tukey's HSD on the first postoperative day, the average eGFR score of Group N compared to D and P were significantly difference (P<0.001). On the second postoperative day, the eGFR of Group N and D showed no difference (P=0.37), but P showed a difference (P<0.001).Conclusion: We found that the prophylactic use of intravenous N-Acetylcysteine had a protective effect on renal function, whereas the application of renal dose dopamine did not have a protective effect in patients with pre-existing moderate renal failure.

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“…1). A total of 70 studies (5,554 patients) met eligibility criteria [17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86] (table 1). …”

Section: Resultsmentioning

confidence: 99%

“…Predefined criteria for acute renal replacement therapy initiation were provided in 7 of these studies and were not uniform across studies [25,27,40,55,56,77,81]. In 1 case, initiation was determined by blinded nephrologists without specific parameters described [81].…”

Section: Resultsmentioning

confidence: 99%

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Prevention and Treatment of Acute Kidney Injury in Patients Undergoing Cardiac Surgery: A Systematic Review

et al. 2010

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Background: Acute kidney injury (AKI) is common in patients undergoing cardiac surgery and is associated with a high rate of death, long-term sequelae and healthcare costs. We conducted a systematic review of randomized controlled trials for strategies to prevent or treat AKI in cardiac surgery. Methods: We screened Medline, Scopus, Cochrane Renal Library, and Google Scholar for randomized controlled trails in cardiac surgery for prevention or treatment of AKI in adults. Results: We identified 70 studies that contained a total of 5,554 participants published until November 2008. Most studies were small in sample size, were single-center, focused on preventive strategies, and displayed wide variation in AKI definitions. Only 26% were assessed to be of high quality according to the Jadad criteria. The types of strategies with possible protective efficacy were dopaminergic agents, vasodilators, anti-inflammatory agents, and pump/perfusion strategies. When analyzed separately, dopamine and N-acetylcysteine did not reduce the risk for AKI. Conclusions: This summary of all the literature on prevention and treatment strategies for AKI in cardiac surgery highlights the need for better information. The results advocate large, good-quality, multicenter studies to determine whether promising interventions reliably reduce rates of acute renal replacement therapy and mortality in the cardiac surgery setting.

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N-acetylcysteine for preventing acute kidney injury in cardiac surgery patients with pre-existing moderate renal insufficiency

Cited by 66 publications

References 48 publications

Preoperative Estimates of Glomerular Filtration Rate as Predictors of Outcome after Surgery

Preoperative Estimates of Glomerular Filtration Rate as Predictors of Outcome after Surgery

N-acetylcysteine Versus Dopamine to Prevent Acute Kidney Injury After Cardiac Surgery In Patients with Pre-existing Moderate Renal Insufficiency

Prevention and Treatment of Acute Kidney Injury in Patients Undergoing Cardiac Surgery: A Systematic Review

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