title: N-acetylcysteine plus deferoxamine for patients with prolonged hypotension does not decrease acute kidney injury incidence: a double blind, randomized, placebo-controlled trial.
abstract: The aim was to test the primary hypothesis that in patients suffering from shock, treatment with N-acetylcysteine (NAC) plus deferoxamine (DFX) decreases the incidence of acute kidney injury (AKI).
  
  
  
  A double-blind, randomized, placebo-controlled trial was conducted in a general intensive care unit in an academic hospital. Patients were included if they had new-onset hypotension, defined as mean arterial blood pressure <60 mmHg or requirement for vasopressor medication. A loading dose of NAC or placebo of 50 mg/kg in 4 h was administered intravenously. After the loading dose, patients received 100 mg/kg/day for the next 48 h. DFX or placebo was administered once at 1000 mg at a rate of 15/mg/kg/h. The primary outcome was the incidence of AKI.
  
  
  
  A total of 80 patients were enrolled in the study. The incidence of AKI was 67 % in the placebo arm and 65 % in the treatment group (relative risk (RR) 0.89 (0.35-2.2)). Furthermore, NAC plus DFX was effective in decreasing the severity and duration of AKI, and patients in the treatment group had lower serum creatinine levels at discharge. No severe adverse event associated with treatment was reported. The effects of NAC plus DFX could be secondary to the attenuation of early inflammatory response and oxidative damage.
  
  
  
  The administration of NAC plus DFX to critically ill patients who had a new episode of hypotension did not decrease the incidence of AKI.
  
  
  
  Clinicaltrials.gov NCT00870883 (Registered 25 March 2009.).
authors.affiliation: Pathophysiology Laboratory, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil.|Intensive Care Unit, São José Hospital, Criciúma, SC, Brazil.
authors.forename: Cassiana Mazon
authors.initials: CM
authors.lastname: Fraga
authors.affiliation: Pathophysiology Laboratory, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil.
authors.forename: Cristiane Damiani
authors.initials: CD
authors.lastname: Tomasi
authors.affiliation: Intensive Care Unit, São José Hospital, Criciúma, SC, Brazil.|São José Hospital Research Centre, Criciúma, SC, Brazil.
authors.forename: Danusa de Castro
authors.initials: DC
authors.lastname: Damasio
authors.affiliation: Pathophysiology Laboratory, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil.
authors.forename: Francieli
authors.initials: F
authors.lastname: Vuolo
authors.affiliation: Pathophysiology Laboratory, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil.|Intensive Care Unit, São José Hospital, Criciúma, SC, Brazil.
authors.forename: Cristiane
authors.initials: C
authors.lastname: Ritter
authors.affiliation: Pathophysiology Laboratory, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil. fdpizzol@gmail.com.|Intensive Care Unit, São José Hospital, Criciúma, SC, Brazil. fdpizzol@gmail.com.|Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Avenida Universitária 1105, 88006-000, Criciúma, SC, Brazil. fdpizzol@gmail.com.
authors.forename: Felipe
authors.initials: F
authors.lastname: Dal-Pizzol
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000453:epidemiology; D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000453:epidemiology / Q000628:therapy*; D003676:Deferoxamine / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D016166:Free Radical Scavengers / Q000008:administration & dosage; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000453:epidemiology; D015994:Incidence; D007362:Intensive Care Units / Q000639:trends; D008297:Male; D008875:Middle Aged
chemical_list: D016166:Free Radical Scavengers; D003676:Deferoxamine; D000111:Acetylcysteine
keywords: Acute kidney injury; Antioxidants; Inflammation; Oxidative stress; Shock