title: High dose of N-acetylcystein prevents acute kidney injury in chronic kidney disease patients undergoing myocardial revascularization.
abstract: BACKGROUND
  The renoprotective effect of N-acetylcystein in patients undergoing coronary artery bypass graft surgery is controversial.
  
  
  METHODS
  We assessed the renoprotective effect of the highest dose of N-acetylcystein sanctioned for clinical use in a prospective, double-blind, placebo-controlled study including 70 chronic kidney disease patients, stage 3 or 4, who underwent coronary artery bypass graft surgery, on cardiopulmonary bypass (CPB) and off CPB, and were randomly allocated to receive either N-acetylcystein 150 mg/kg followed by 50 mg/kg for 6 hours in 0.9% saline or only 0.9% saline. Acute kidney injury was defined by the Acute Kidney Injury Network classification.
  
  
  RESULTS
  The incidence of kidney injury was reduced in the N-acetylcystein group (57.1% versus 28.6%, p=0.016). Nonuse of N-acetylcystein (relative risk 3.58, 95% confidence interval: 1.04 to 12.33, p=0.04) and cardiopulmonary bypass (relative risk 4.55, 95% confidence interval: 1.28 to 16.15, p=0.02) were independent predictors of kidney injury. In patients treated with CPB, N-acetylcystein reduced the incidence of kidney injury from 63% to 46%. Oxidative stress was increased in control subjects (p=0.01) and abolished in patients receiving N-acetylcystein.
  
  
  CONCLUSIONS
  Maximum intravenous doses of N-acetylcystein reduce the incidence of acute kidney injury in patients with kidney disease undergoing coronary artery bypass graft surgery, abolish oxidative stress, and mitigate the negative effect of CPB on renal function.
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Eduesley
authors.initials: E
authors.lastname: Santana-Santos
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Luis Henrique W
authors.initials: LH
authors.lastname: Gowdak
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Fabio A
authors.initials: FA
authors.lastname: Gaiotto
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Luiz B
authors.initials: LB
authors.lastname: Puig
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Ludhmila A
authors.initials: LA
authors.lastname: Hajjar
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Suely P
authors.initials: SP
authors.lastname: Zeferino
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Luciano F
authors.initials: LF
authors.lastname: Drager
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Maria Heloisa M
authors.initials: MH
authors.lastname: Shimizu
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Luiz A
authors.initials: LA
authors.lastname: Bortolotto
authors.affiliation: Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: jose.lima@incor.usp.br.
authors.forename: Jose J G
authors.initials: JJ
authors.lastname: De Lima
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D058186:Acute Kidney Injury / Q000517:prevention & control*; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011379:Prognosis; D011446:Prospective Studies; D020551:Pulse Therapy, Drug / Q000379:methods*; D011859:Radiography; D012016:Reference Values; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000111:Acetylcysteine