Abstract 9376: Maximum Dose of N-acetylcysteine and Prevention of Renal Dysfunction in Patients With Chronic Kidney Disease Undergone Surgical Coronary Intervention: A Prospective, Randomized, Double-blind, Controlled Trial
Background: The role of N-acetylcysteine (NAC) for the prevention of renal damage in experimental models and in diverse clinical settings is controversial. Disparate results may be caused by differences in dosing and route administration. Objective: to test the safety and efficacy of maximum IV dose of NAC, as recommended for acetaminophen overdose, on the incidence of renal dysfunction, in 50 patients with GFR <60/≥15 ml/min (64±9 yo, Caucasians 80%, men 74%, diabetics 56%, comorbidities 90%, LVEF 54%±11%, GFR 45±11 ml/min, Euroscore 5.4%) undergone elective surgical coronary intervention (CI).
Methods: patients were randomized to receive either IV saline (n=26) or NAC (n= 24) in equal volume of saline (150 mg/Kg followed by 50 mg/kg) during surgery. End-points: renal dysfunction (AKIN criteria), serum NGAL and TBARS during the first 72-h post-operation; need of dialysis and death within 30-days post-operation.
Results: NAC was not associated with significant side-effects. There was one death in the NAC group (cardiac arrest) and none among controls and no patient needed dialysis. Base-line age, gender, race, diabetes, dyslipidemia, smoking, comorbidities, GFR, Euroscore, and number of grafts, on-pump surgery, transfusions, vasoactive drugs and diuresis (during and after operation) did not differ between groups. Renal dysfunction was observed in 64% (controls) and 27% (NAC) patients (p= 0.02) and no use of NAC was the only independent predictor of renal dysfunction (OR= 4.86, p=0.02). NGAL and TBARS were higher in patients not receiving NAC (=< 0.05).
Conclusion: maximum IV dosing of NAC was well tolerated and was associated with reduction on the incidence of renal dysfunction in patients with CKD undergone surgical coronary intervention. More work is needed to determine the optimal dosing of NAC in this setting.
- © 2012 by American Heart Association, Inc.