title: Effectiveness of N-acetylcysteine for preserving residual renal function in patients undergoing maintenance hemodialysis: multicenter randomized clinical trial.
abstract: BACKGROUND
  To investigate the efficacy and safety of oral N-acetylcysteine (NAC) for preserving residual renal function in patients undergoing hemodialysis.
  
  
  METHODS
  Randomized, multi-center, parallel-group, open-label clinical trial (Registration No. IRCT 2014071418482N1). 54 patients who have been undergoing hemodialysis for at least 3 months and had residual urine volume >100 ml/24 h were randomly allocated to NAC or no medication. Residual renal function evaluated by (1) estimated glomerular filtration rate (GFR), (2) 24 h urine volume, and (3) renal Kt/V. GFR and Kt/V was determined at baseline and after 3 months. 24 h urine volume was measured at baseline, after 1, 2, and 3 months.
  
  
  RESULTS
  Intention-to-treat analysis was performed on 47 patients (NAC = 26, control = 21). GFR in patients receiving NAC improved, whereas in the control arm a decline of 1.0 ml/min/1.73 m2was recorded (3.59 vs. 2.11 ml/min/1.73 m2, effect size = 17.0 %, p = 0.004). For 24 h urine volume, the between-group difference after 1 month was significant (669 vs. 533 ml/24 h, effect size = 15.4 %, p = 0.004). After 3 months, 24 h urine volume in the NAC arm was on average 137 ml higher than in the control group, and the difference reached near significance (673 vs. 536 ml/24 h, p = 0.072). In the follow-up visit, Kt/V was higher in the NAC arm but the difference did not reach statistical significance (0.81 vs. 0.54, p = 0.152).
  
  
  CONCLUSIONS
  Three months treatment with NAC appears to be effective in preserving renal function in patients undergoing hemodialysis and the medication is generally well-tolerated.
authors.affiliation: Nephrology Research Center, Imam Khomeni Hospital, Tehran University of Medical Sciences, Tehran, Iran. ahmadifa@tums.ac.ir.|Center of Excellence in Nephrology, Tehran, Iran. ahmadifa@tums.ac.ir.
authors.forename: Farrokhlaga
authors.initials: F
authors.lastname: Ahmadi
authors.affiliation: Nephrology Research Center, Imam Khomeni Hospital, Tehran University of Medical Sciences, Tehran, Iran.|Center of Excellence in Nephrology, Tehran, Iran.
authors.forename: Mahsa
authors.initials: M
authors.lastname: Abbaszadeh
authors.affiliation: Nephrology Research Center, Imam Khomeni Hospital, Tehran University of Medical Sciences, Tehran, Iran.|Center of Excellence in Nephrology, Tehran, Iran.
authors.forename: Effat
authors.initials: E
authors.lastname: Razeghi
authors.affiliation: Department of Nephrology, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Sima
authors.initials: S
authors.lastname: Maziar
authors.affiliation: Nephrology Research Center, Imam Khomeni Hospital, Tehran University of Medical Sciences, Tehran, Iran.|Center of Excellence in Nephrology, Tehran, Iran.
authors.forename: Simin Dashti
authors.initials: SD
authors.lastname: Khoidaki
authors.affiliation: Nephrology Research Center, Imam Khomeni Hospital, Tehran University of Medical Sciences, Tehran, Iran.|Center of Excellence in Nephrology, Tehran, Iran.
authors.forename: Mohammad Taghi
authors.initials: MT
authors.lastname: Najafi
authors.affiliation: Nephrology Research Center, Imam Khomeni Hospital, Tehran University of Medical Sciences, Tehran, Iran.|Center of Excellence in Nephrology, Tehran, Iran.
authors.forename: Mahboob
authors.initials: M
authors.lastname: Lessan-Pezeshki
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage* / Q000009:adverse effects; D000284:Administration, Oral; D000368:Aged; D000975:Antioxidants / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D057194:Intention to Treat Analysis; D007492:Iran; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D006435:Renal Dialysis / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014554:Urination / Q000187:drug effects; D014563:Urodynamics / Q000187:drug effects
chemical_list: D000975:Antioxidants; D000111:Acetylcysteine
keywords: Glomerular filtration rate; Hemodialysis; N-Acetylcysteine; Renal Kt/V; Residual renal function; Urine volume