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BJA Advance Access published online on August 16, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael224
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted July 5, 2006

Clinical Investigation

Lack of renoprotective effect of i.v. N-acetylcysteine in patients with chronic renal failure undergoing cardiac surgery

A. Ristikankare 1 *, T. Kuitunen 2, A. Kuitunen 1, L. Uotila 3, A. Vento 4, R. Suojaranta-Ylinen 1, M. Salmenperä 1, and R. Pöyhiä 1

1 Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland
2 National Agency for Medicines, Helsinki, Finland
3 Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland
4 Department of Cardiac and Thoracic Surgery, Helsinki University Central Hospital, Helsinki, Finland

* To whom correspondence should be addressed.
A. Ristikankare, E-mail: anne.ristikankare{at}hus.fi


  Abstract

Background. Pre-existing chronic renal failure is a significant risk factor for acute renal failure (ARF) after cardiac surgery. N-acetylcysteine (NAC) has been shown to prevent contrast media-induced ARF. Our objective was to evaluate whether i.v. NAC has renoprotective effects in patients with mild renal failure undergoing cardiac surgery.

Methods. In this prospective, randomized, double-blind study, 80 patients with mild to moderate renal failure undergoing elective heart surgery with cardiopulmonary bypass were recruited. All received either i.v. NAC (n=38) or placebo (n=39) at induction of anaesthesia and then up to 20 h. Urine N-acetyl-{beta}--glucosaminidase (NAG) and urine creatinine ratio, plasma creatinine, and serum cystatin C levels indicated renal function.

Results. Levels of urinary NAG/creatinine ratio, plasma creatinine and serum cystatin C did not significantly differ between NAC and placebo groups during five postoperative days. Urine NAG/creatinine ratio increased over 30% in 100% of patients in the NAC group vs 92.3% in the placebo group (P=0.081). Plasma creatinine increased by 25% from baseline or over 44 µmol litre-1 in 42.1% in NAC group vs 48.7% in placebo group (P=0.560). Serum cystatin C exceeded 1.4 mg litre-1 in 78.9% in NAC group vs 61.5% in placebo group (P=0.096).

Conclusions. Prophylactic treatment with i.v. N-acetylcysteine had no renoprotective effect in patients with pre-existing renal failure undergoing cardiac surgery.

Keywords: kidney, failure; surgery, cardiovascular.
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E-letters:

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A premature conclusion
Yahya Shehabi, et al.
British Journal of Anaesthesia, 27 Oct 2006 [Full text]
Lack of renoprotective effect of i.v. N-acetylcysteine in patients with chronic renal failure underg
Anne H. Ristikankare, et al.
British Journal of Anaesthesia, 27 Nov 2006 [Full text]
Lack of renoprotective effect of i.v. N-acetylcysteine in patients with chronic renal failure underg
Patrick G Morgan, et al.
British Journal of Anaesthesia, 13 Mar 2007 [Full text]
Re: Lack of renoprotective effect of i.v. N-acetylcysteine in patients with chronic renal failure un
Anne H Ristikankare, et al.
British Journal of Anaesthesia, 20 Apr 2007 [Full text]

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