Utility of N-acetylcysteine to prevent acute kidney injury after cardiac surgery: a randomized controlled trial.
BACKGROUND
Acute kidney injury (AKI) after heart surgery is associated with increased mortality. We sought to determine whether prophylactic perioperative administration of N-acetylcysteine (NAC) prevents postoperative AKI in patients with chronic kidney disease undergoing cardiac surgery (clinical trials.gov identifier NCT00211653).


METHODS
In this prospective, randomized, placebo-controlled, double-blinded clinical trial, 102 patients with chronic kidney disease who underwent heart surgery at the Minneapolis Veterans Affairs Medical Center were randomized to either NAC (n = 50) 600 mg PO twice daily or placebo (n = 52) for a total of 14 doses (3 preoperative). The primary outcome was maximum change in creatinine from baseline within 7 days after surgery. Secondary outcome was AKI (ie, >0.5 mg/dL or >or=25% increase in creatinine from baseline).


RESULTS
Creatinine increased in both groups (0.45 +/- 0.7 mg/dL in NAC vs 0.55 +/- 0.9 mg/dL in placebo, P = .53) and peaked on postoperative day 5. Acute kidney injury occurred in 41 patients (22 NAC vs 19 placebo, P = .44) by postoperative day 5, but persisted in only 14 (7 NAC vs 7 placebo, P = .94) by day 30. In multivariable analysis, perioperative NAC was unassociated with AKI (relative risk 1.2, 95% CI, 0.8-1.9, P = .34). Five patients (3 NAC vs 2 placebo, P = .68) underwent hemodialysis, and 5 (2 NAC vs 3 placebo, P = 1.0) died perioperatively. There was no difference in lengths of stay in the intensive care unit (4.9 +/- 7 days in NAC vs 6.5 +/- 9 days in placebo, P = .06) and the hospital (13.2 +/- 13 days in NAC vs 16.7 +/- 17 days in placebo, P = .12).


CONCLUSIONS
Prophylactic perioperative NAC administration does not prevent AKI after cardiac surgery.
Division of Cardiology, Veterans Affairs Medical Center, University of Minnesota, Minneapolis, MN 55417, USA. adaba001@umn.edu
A Selcuk
AS
Adabag
Areef
A
Ishani
Suresh
S
Koneswaran
Deborah J
DJ
Johnson
Rosemary F
RF
Kelly
Herbert B
HB
Ward
Edward O
EO
McFalls
Hanna E
HE
Bloomfield
Yellaprada
Y
Chandrashekhar
D000111:Acetylcysteine / Q000008:administration & dosage*; D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology* / Q000517:prevention & control*; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000601:surgery*; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D019990:Perioperative Care; D016896:Treatment Outcome
D003404:Creatinine; D000111:Acetylcysteine