title: Impact of antioxidant supplementations on cardio-renal protection in cardiac surgery: an updated and comprehensive meta-analysis and systematic review.
abstract: This systematic review with meta-analysis sought to determine the strength of evidence in terms of the impact of common antioxidant supplementations, such as N-acetylcysteine (NAC), vitamin C, and polyunsaturated fatty acids (PUFA) on perioperative outcomes after cardiac surgery with particular focus on the incidence of atrial fibrillation (AF) and acute kidney injury (AKI) with associated mortality. A total of 29 trials were identified that reported incidence of AF and 17 trials that reported incidence of AKI. Pooled analysis reported that NAC (OR=0.5; P=.001), vitamin C (OR=0.4; P=.001), and PUFA (OR=0.8; P=.01) administration were associated with significantly reduced incidence of AF. In terms of postoperative AKI, only NAC was shown to be a beneficial supplement that was able to significantly reduce the incidence of AKI (OR=0.7; P=.01), and NAC could also significantly decrease overall mortality (OR=0.3; P=.03) following cardiac surgery. The use of NAC in patients undergoing cardiac surgery should be strongly recommended due to its combined cardio-renal protective effects and reduced mortality. Also, PUFA and vitamin C might be able to significantly decrease the incidence of arrhythmia; however, reno-protective effects and impact on overall mortality of these supplements seem to be less impressive.
authors.forename: Sadeq
authors.initials: S
authors.lastname: Ali- Hasan- Al- Saegh
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Seyed Jalil
authors.initials: SJ
authors.lastname: Mirhosseini
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Mahbube
authors.initials: M
authors.lastname: Tahernejad
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Parisa
authors.initials: P
authors.lastname: Mahdavi
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Shahidzadeh
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Ali Akbar
authors.initials: AA
authors.lastname: Karimi-Bondarabadi
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Ali-Mohammad
authors.initials: AM
authors.lastname: Dehghan
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Elham
authors.initials: E
authors.lastname: Rahimizadeh
authors.affiliation: Department of Physiology, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Haddad
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Ghodratipour
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Sarrafan-Chaharsoughi
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Arezoo
authors.initials: A
authors.lastname: Shahidzadeh
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Azam
authors.initials: A
authors.lastname: Ghanei
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Lotfaliani
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zeriouh
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, UK.|Department of Thoracic and Cardiovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Weymann
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
authors.forename: Aron-Frederik
authors.initials: AF
authors.lastname: Popov
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
authors.forename: Anton
authors.initials: A
authors.lastname: Sabashnikov
mesh_terms: D000111:Acetylcysteine / Q000009:adverse effects / Q000627:therapeutic use*; D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D000975:Antioxidants / Q000009:adverse effects / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D019587:Dietary Supplements; D005231:Fatty Acids, Unsaturated / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000975:Antioxidants; D005231:Fatty Acids, Unsaturated; D001205:Ascorbic Acid; D000111:Acetylcysteine
keywords: Acute renal injury; Atrial fibrillation; Cardiac surgery; N-acetylcysteine; Polyunsaturated fatty acids; Vitamin C