Intravenous N-acetylcysteine during haemodialysis reduces the plasma concentration of homocysteine in patients with end-stage renal disease.
BACKGROUND
Hyperhomocysteinaemia is an independent cardiovascular risk factor in patients with renal disease. The current study aimed to determine the effect of intravenous N-acetylcysteine on plasma homocysteine levels when administered during haemodialysis in patients with end-stage renal failure.


METHODS
Sixty patients with end-stage renal failure were randomised to receive a 4-hour intravenous infusion of N-acetylcysteine or placebo during a 4-hour haemodialysis session. Plasma homocysteine levels were measured before and after haemodialysis. Haemodynamic parameters, including pulse pressure, were also measured.


RESULTS
After haemodialysis in the placebo treatment group, plasma homocysteine was reduced by 23.7% from the pre-dialysis level, whereas patients treated with N-acetylcysteine exhibited an 88.3% decrease (p < 0.001). Reduction of plasma homocysteine concentration was significantly correlated with a reduction of pulse pressure (p = 0.001). A 10% decrease in plasma homocysteine concentration was associated with a 1.45mm Hg decrease in pulse pressure.


CONCLUSIONS
Intravenous administration of N-acetylcysteine during haemodialysis normalises plasma homocysteine concentration, and this is associated with improved pulse pressure in patients with end-stage renal failure. Intravenous administration of N-acetylcysteine during haemodialysis may be a promising approach to help reduce cardiovascular risk in this vulnerable group of patients.
Thaha
Mochammad
M
Nephrology-Hypertension Division, Department of Internal Medicine, Airlangga School of Medicine, Dr Soetomo Teaching Hospital, Surabaya, Indonesia. mochthala@yahoo.com
Yogiantoro
Mohammad
M
Tomino
Yasuhiko
Y
D000111:Acetylcysteine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D001798:Blood Proteins / Q000032:analysis; D003928:Diabetic Nephropathies / Q000175:diagnosis; D004334:Drug Administration Schedule; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006400:Hematocrit; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis; D007262:Infusions, Intravenous; D007669:Kidney Calculi / Q000175:diagnosis; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome; D014581:Urticaria / Q000139:chemically induced
D001798:Blood Proteins; D006710:Homocysteine; D000111:Acetylcysteine