Effect of oral N-acetylcysteine treatment on plasma inflammatory and oxidative stress markers in peritoneal dialysis patients: a placebo-controlled study.
BACKGROUND
Inflammation and oxidative stress (OS) are cardiovascular risk factors in patients with chronic kidney disease. N-acetylcysteine (NAC) is a thiol-containing antioxidant with anti-inflammatory properties and has been shown to reduce the number of cardiovascular events in hemodialysis patients.


METHODS
The current study aimed to determine the effect of oral NAC (2 x 600 mg/daily) on plasma levels of inflammatory and OS markers in peritoneal dialysis (PD) patients. We performed a placebo-controlled study over 8 weeks in 30 patients (40% males, age 52 +/- 13 years) on regular PD. Before the study was started, the patients were divided into 2 groups of 15 patients matched for age and gender. 22 patients completed the study (12 on NAC, 10 on placebo). Proinflammatory cytokines [high-sensitivity C-reactive protein, interleukin-6 (IL-6), tumor necrosis factor-alpha, and pentraxin 3] and markers of OS (pentosidine, advanced oxidation protein products, homocysteine, glutathione, asymmetric dimethylarginine, and free sulfhydryls) were measured before and after treatment with NAC.


RESULTS
Treatment with NAC for 8 weeks increased mean baseline plasma NAC levels from 2.6 to 24.8 mumol/L (p = 0.007). This intervention, which caused no side effects, significantly diminished IL-6 levels, from 9.4 (4.5 - 31) to 7.6 (4.9 - 13.5) pg/mL (p = 0.006), whereas no such changes were observed in the placebo group. NAC treatment did not significantly affect the other inflammatory and OS markers.


CONCLUSIONS
Short-term oral NAC treatment resulted in reduction of circulating IL-6, suggesting that such treatment could be a useful strategy in blunting the inflammatory response in PD patients.
Nascimento
Marcelo M
MM
Faculdade Evangélica de Medicina do Paraná-Brasil, Curitiba, Brazil. marcelo.mazza.do.nascimento@ki.se
Suliman
Mohamed E
ME
Silva
Margarete
M
Chinaglia
Tiago
T
Marchioro
Josiane
J
Hayashi
Shirley Y
SY
Riella
Miguel C
MC
Lindholm
Bengt
B
Anderstam
Björn
B
D000111:Acetylcysteine / Q000008:administration & dosage*; D000284:Administration, Oral; D000368:Aged; D000975:Antioxidants / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases; D005260:Female; D006801:Humans; D007249:Inflammation / Q000188:drug therapy*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects*; D010530:Peritoneal Dialysis; D012307:Risk Factors; D000683:Serum Amyloid P-Component / Q000032:analysis; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D000099153:Pentraxins
D000111:Acetylcysteine; D000975:Antioxidants; D015415:Biomarkers; D002097:C-Reactive Protein; D015850:Interleukin-6; D000683:Serum Amyloid P-Component; D014409:Tumor Necrosis Factor-alpha; D000099153:Pentraxins