The effect of N-acetylcysteine on blood pressure and markers of cardiovascular risk in non-diabetic patients with chronic kidney disease: a placebo-controlled, randomized, cross-over study.
BACKGROUND
Cardiovascular complications in patients with chronic kidney disease (CKD) are frequent. They show increased cardiovascular mortality and morbidity attributable to accumulation of several risk factors; e.g., hypertension, oxidative stress and elevated plasma homocysteine concentration. Despite recent progress in their management, there is still no optimal therapy that can stop progression of CKD and decrease cardiovascular outcome in these patients. Antioxidants, e.g., N-acetylcysteine (NAC), have been suggested as a promising medicament in this field.


METHODS
In a placebo-controlled, randomized, two-period cross-over study we evaluated the influence of eight weeks of NAC therapy (1200 mg/day) added to pharmacological renin-angiotensin system blockade on ambulatory blood pressure and surrogate markers of cardiovascular risk and injury in 20 non-diabetic patients with albuminuria [30-915 mg per creatinine mg] and normal or slightly decreased kidney function [eGFR 61-163 ml/min]. After eight weeks run-in period during which the therapy using angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers was settled, patients were randomly assigned to one of two treatment sequences: NAC/washout/placebo or placebo/washout/NAC.


RESULTS
No significant changes in blood pressure, albuminuria and homocysteine plasma level were observed.


CONCLUSIONS
NAC had no effect on blood pressure and surrogate markers of cardiovascular injury in non-diabetic patients with CKD.
Renke
Marcin
M
Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland. mrenke@gumed.edu.pl
Tylicki
Leszek
L
Rutkowski
Przemysław
P
Larczynski
Wojciech
W
Neuwelt
Alexander
A
Aleksandrowicz
Ewa
E
Łysiak-Szydłowska
Wiesława
W
Rutkowski
Bolesław
B
D000111:Acetylcysteine / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000150:complications; D015415:Biomarkers / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000150:complications* / Q000503:physiopathology*; D018592:Cross-Over Studies; D048909:Diabetes Complications / Q000503:physiopathology; D005260:Female; D016166:Free Radical Scavengers / Q000494:pharmacology / Q000627:therapeutic use; D006710:Homocysteine / Q000097:blood; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D010919:Placebos; D011506:Proteins / Q000378:metabolism; D012307:Risk Factors; D012964:Sodium / Q000378:metabolism; D055815:Young Adult
D015415:Biomarkers; D016166:Free Radical Scavengers; D010919:Placebos; D011506:Proteins; D006710:Homocysteine; D012964:Sodium; D000111:Acetylcysteine