title: Addition of N-acetyl cysteine to carvedilol decreases the incidence of acute renal injury after cardiac surgery.
abstract: BACKGROUND
  Oxidative stress and inflammation during cardiac surgery may be associated with acute renal injury (ARI). N-acetyl cysteine (NAC) and carvedilol have antioxidant and anti-inflammatory properties.
  
  
  OBJECTIVE
  A combination of carvedilol and NAC should decrease the incidence of ARI more than metoprolol or carvedilol.
  
  
  METHODS
  Patients undergoing cardiac surgery were randomized to metoprolol, carvedilol, or carvedilol plus NAC. End points were occurrence of ARI and change in preoperative to postoperative peak creatinine levels.
  
  
  RESULTS
  ARI incidence was lower in the carvedilol plus NAC group compared with the metoprolol (21.0% vs 42.1%; P = 0.002) or carvedilol (21.0% vs 38.6%; P = 0.006) groups, but was similar between the metoprolol and carvedilol groups (P = 0.62). Preoperative and postoperative day 1 creatinine levels were similar among the metoprolol (1.02 [0.9-1.2] and 1.2 [0.92-1.45]) the carvedilol (1.0 [0.88-1.08] and 1.2 [0.9-1.5]) and the carvedilol plus NAC groups (1.06 [0.9-1.18] and 1.1 [1.0-1.21] mg/dL; all P values >0.05). Postoperative day 3, day 5, and peak creatinine levels were lower in the carvedilol plus NAC group (1.11 [1.0-1.23], 1.14 [1.0-1.25] and 1.15 [1.0-1.25]) as compared with the metoprolol (1.4 [1.3-1.49], 1.3 [1.0-1.54] and 1.3 [1.0-1.54]) or carvedilol groups (1.2 [1.0-1.52], 1.25 [1.0-1.52] and 1.25 [1.0-1.55] mg/dL; all P values <0.05), but were similar between the metoprolol and carvedilol groups (all P values >0.05).
  
  
  CONCLUSIONS
  Combined carvedilol and NAC decreased ARI incidence as compared with carvedilol or metoprolol. No difference was detected between carvedilol and metoprolol.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozaydin
authors.forename: Tulay
authors.initials: T
authors.lastname: Peker
authors.forename: Selahaddin
authors.initials: S
authors.lastname: Akcay
authors.forename: Bayram A
authors.initials: BA
authors.lastname: Uysal
authors.forename: Habil
authors.initials: H
authors.lastname: Yucel
authors.forename: Atilla
authors.initials: A
authors.lastname: Icli
authors.forename: Dogan
authors.initials: D
authors.lastname: Erdogan
authors.forename: Ercan
authors.initials: E
authors.lastname: Varol
authors.forename: Abdullah
authors.initials: A
authors.lastname: Dogan
authors.forename: Huseyin
authors.initials: H
authors.lastname: Okutan
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D058671:Adrenergic beta-1 Receptor Antagonists / Q000627:therapeutic use*; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000975:Antioxidants / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002227:Carbazoles / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D000077261:Carvedilol; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use; D008875:Middle Aged; D011412:Propanolamines / Q000627:therapeutic use*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D000893:Anti-Inflammatory Agents; D000975:Antioxidants; D015415:Biomarkers; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D003404:Creatinine; D008790:Metoprolol; D000111:Acetylcysteine