title: N-Acetyl Cysteine Therapy Does Not Prevent Renal Failure in High-Risk Patients Undergoing Open-Heart Surgery.
abstract: BACKGROUND
  Renal dysfunction is a common complication after cardiovascular surgery. Controversial issues have been discussed regarding the role of N-acetyl cysteine in the prevention of postoperative renal dysfunction. The purpose of this meta-analysis is to assess whether N-acetyl cysteine offers any protection against the development of acute renal dysfunction after cardiac surgery.
  
  
  METHODS
  Multiple databases were searched for randomized trials comparing the role of N-acetyl cysteine and placebo in human patients undergoing cardiac surgery. End-points studied were: the incidence of acute renal failure, hemodialysis, early mortality, duration of hospital stay, and maximal change in creatinine values. Dichotomous variables were compared using the risk difference (RD) calculated with inverse weighting; continuous data was pooled as (standardized) mean difference. Results are presented with 95% confidence interval (P &lt; .05 is significant); results are presented within 95% confidence interval.
  
  
  RESULTS
  Thirteen randomized trials (713 and 707 patients in the N-acetyl cysteine and control groups, respectively) were included in the present analysis; nine dealing with patients at high-risk for acute renal failure. The incidence of postoperative acute renal dysfunction was 23% and 36% in the N-acetyl cysteine and control cohorts, respectively. N-acetyl cysteine therapy did not reduce acute renal dysfunction in the high-risk cohort [RD -0.03 (-0.09 to 0.02); P = .22; I2 = 24%]. Maximal change in creatinine levels after surgery was also comparable [standardized mean difference 0.07 (-0.23, 0.09); P = .39]. Early mortality was 2.9% and 3.7% in the N-acetyl cysteine and control cohorts respectively; [RD 0 (-0.03 to 0.02); P = .63; I2 = 20%]. Hospital stay (mean length of stay 10.4 and 10.1 days in the N-acetyl cysteine and control cohorts, respectively) was also similar in both cohorts [WMD 0.17 (-0.02 to 0.37) days; P = .81].
  
  
  CONCLUSIONS
  Prophylactic N-acetyl cysteine therapy does not reduce the incidence of renal dysfunction in high-risk patients undergoing cardiac surgery.
authors.affiliation: Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Abeer M
authors.initials: AM
authors.lastname: Rababa'h
authors.affiliation: Department of Cardiovascular Surgery, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Salil V
authors.initials: SV
authors.lastname: Deo
authors.affiliation: Department of Cardiac Surgery, Queen Alia Heart Institute, Amman, Jordan.
authors.forename: Salah E
authors.initials: SE
authors.lastname: Altarabsheh
authors.affiliation: Cleveland Health Sciences Library, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: De Caro
authors.affiliation: Department of Physiology and Biochemistry, Faculty of Medicine, The University of Jordan, Amman, Jordan.
authors.forename: Nafez Abu
authors.initials: NA
authors.lastname: Tarboush
authors.affiliation: Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Karem H
authors.initials: KH
authors.lastname: Alzoubi
authors.affiliation: Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Mera
authors.initials: M
authors.lastname: Ababneh
authors.affiliation: Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Texas Medical Center, Houston, Texas, USA.
authors.forename: Bradley K
authors.initials: BK
authors.lastname: McConnell
authors.affiliation: Department of Cardiovascular Surgery, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Markowitz
authors.affiliation: Department of Cardiovascular Surgery, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D058186:Acute Kidney Injury / Q000401:mortality* / Q000517:prevention & control*; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D016166:Free Radical Scavengers / Q000008:administration & dosage / Q000627:therapeutic use; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control*; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012076:Renal Agents; D012307:Risk Factors; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D016166:Free Radical Scavengers; D012076:Renal Agents; D000111:Acetylcysteine