title: Phase II, randomized, controlled trial of high-dose N-acetylcysteine in high-risk cardiac surgery patients.
abstract: OBJECTIVE
  To assess the effect of high-dose N-acetylcysteine on renal function in cardiac surgery patients at higher risk of postoperative renal failure.
  
  
  METHODS
  Multiblind, placebo-controlled, randomized, phase II clinical trial.
  
  
  METHODS
  Operating rooms and intensive care units of two tertiary referral hospitals.
  
  
  METHODS
  A total of 60 cardiac surgery patients at higher risk of postoperative renal failure.
  
  
  METHODS
  Patients were allocated to either 24 hrs of high-dose N-acetylcysteine infusion (300 mg/kg body weight in 5% glucose, 1.7 L) or placebo (5% glucose, 1.7 L).
  
  
  RESULTS
  The primary outcome measure was the absolute change in serum creatinine from baseline to peak value within the first five postoperative days. Secondary outcomes included the relative change in serum creatinine, peak serum creatinine level, serum cystatin C, and in urinary output. Further outcomes were needed for renal replacement therapy, length of ventilation, and length of stay in the intensive care unit and hospital. Randomization was successful and patients were well balanced for preoperative and intraoperative characteristics. There was no significant attenuation in the increase in serum creatinine from baseline to peak when comparing N-acetylcysteine with placebo (64.5 +/- 91.2 and 38.0 +/- 42.4 mumol/L, respectively; p = .15). Also, there was no attenuation in the increase in serum cystatin C from baseline to peak for N-acetylcysteine compared with placebo (0.45 +/- 0.43 and 0.30 +/- 0.33 mg/L, respectively; p = .40). Likewise, there was no evidence for differences in any other clinical outcome.
  
  
  CONCLUSIONS
  In this phase II, randomized, controlled trial, high-dose N-acetylcysteine was no more effective than placebo in attenuating cardiopulmonary bypass-related acute renal failure in high-risk cardiac surgery patients.
authors.affiliation: Department of Intensive Care, Austin Hospital, University of Melbourne, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Haase
authors.forename: Anja
authors.initials: A
authors.lastname: Haase-Fielitz
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.forename: Michael C
authors.initials: MC
authors.lastname: Reade
authors.forename: Stanislao
authors.initials: S
authors.lastname: Morgera
authors.forename: Siven
authors.initials: S
authors.lastname: Seevenayagam
authors.forename: George
authors.initials: G
authors.lastname: Matalanis
authors.forename: Brian
authors.initials: B
authors.lastname: Buxton
authors.forename: Laurie
authors.initials: L
authors.lastname: Doolan
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D003404:Creatinine / Q000097:blood*; D005260:Female; D016166:Free Radical Scavengers / Q000008:administration & dosage*; D006801:Humans; D007668:Kidney / Q000187:drug effects; D019344:Lactic Acid / Q000097:blood; D008297:Male; D011292:Premedication; D011300:Preoperative Care; D016896:Treatment Outcome
chemical_list: D016166:Free Radical Scavengers; D019344:Lactic Acid; D003404:Creatinine; D000111:Acetylcysteine