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N-acetylcysteine for prevention of acute renal failure in patients with chronic renal insufficiency undergoing cardiac surgery: A prospective, randomized, clinical trial*

Sisillo, Erminio MD; Ceriani, Roberto MD; Bortone, Franco MD; Juliano, Glauco MD; Salvi, Luca MD; Veglia, Fabrizio PhD; Fiorentini, Cesare MD; Marenzi, Giancarlo MD

doi: 10.1097/01.CCM.0000295305.22281.1D
Clinical Investigations
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Objective: To assess the preventive effect of the antioxidant N-acetylcysteine on postoperative acute renal failure in patients with renal insufficiency undergoing cardiac surgery.

Design: Randomized, placebo-controlled, prospective study.

Setting: University cardiology center.

Patients: Two hundred fifty-four consecutive patients with chronic renal insufficiency (estimated creatinine clearance ≤60 mL/min) undergoing elective cardiac surgery.

Interventions: Patients were randomized to receive N-acetylcysteine (n = 129) or placebo (n = 125). Patients of the N-acetylcysteine group received four boluses of intravenous N-acetylcysteine (1200 mg every 12 hrs, starting immediately before cardiac surgery).

Measurements and Main Results: The incidence of postoperative acute renal failure (>25% increase in serum creatinine from baseline) and the in-hospital clinical course were evaluated. Acute renal failure occurred in 46% of patients and was associated with increased in-hospital mortality (7% vs. 0.7%; p = .024). It occurred in 52% of control patients and 40% of N-acetylcysteine-treated patients (p = .06). In-hospital mortality and need for renal replacement therapy were not affected by N-acetylcysteine, but a lower percentage of N-acetylcysteine-treated patients required mechanical ventilation prolonged for >48 hrs (3% vs. 18%; p < .001) and had an intensive care unit stay >4 days (13% vs. 33%; p < .001).

Conclusions: Intravenous administration of N-acetylcysteine does not clearly prevent postoperative acute renal failure in patients with renal insufficiency undergoing cardiac surgery.

From the Anesthesia and Critical Care Unit (ES, GJ, LS), Intensive Cardiac Care Unit (CF, GM), and Statistical Unit (FV) of the Centro Cardiologico Monzino, I.R.C.C.S, Institute of Cardiology, University of Milan, Milan; and the Department of Anesthesia and Intensive Care (RC, FB), Istituto Humanitas-Gavazzeni, Bergamo, Italy.

Supported, in part, by Centro Cardiologico Monzino, I.R.C.C.S, Institute of Cardiology, University of Milan, and the Italian Ministry of Health (RC2005/2006; CC03).

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: giancarlo.marenzi@ccfm.it

© 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins