Effects of N-acetyl cysteine on renal functions evaluated by blood neutrophil gelatinase-associated lipocalin levels in geriatric patients undergoing coronary artery bypass grafting

Abstract

Objective:Recent conflicting studies on the renal effects of N-acetyl cysteine (NAC) after cardiac surgery have been published. The aim of this study was to evaluate the renal effects of NAC using neutrophil gelatinase-associated lipocalin (NGAL) blood levels in elderly patients undergoing coronary artery bypass grafting (CABG).Methods:This randomized, double-blinded, placebo-controlled study was conducted among geriatric patients (>65 years) scheduled to undergo CABG. A total of 60 consecutive patients were randomly assigned to 2 groups. The first group received I.V. NAC (n=30) and the second group received placebo (n=30) at induction of anesthesia and then for 20 h. NGAL values were determined and conventional renal function tests were performed. Statistical analysis was performed using SPSS 17.0 (IL, Chicago, USA). A p value of <0.05 was considered statistically significantResults:Plasma creatinine levels at 24 h postoperatively were significantly higher in the placebo group than in the NAC group (1.41±0.63 vs. 1.13±0.35; p<0.05). The mean serum NGAL levels at 3 h postoperatively were higher in the placebo group than in the NAC group (104.94±30.51 vs. 87.82±25.18; p<0.05). NGAL levels were similar between the groups at all other measurement time points. Plasma creatinine levels of ≥1.5 mg/dL or >25% of the baseline value at any time during the study period were observed in 27% of patients in the NAC group and 37% of patients in the placebo group; the difference was statistically significant (p<0.05).Conclusion:In the present study, we found that I.V. NAC infusion in elderly patients undergoing CABG reduced the incidence of acute kidney injury as determined by blood NGAL and creatinine levels.

N-acetylcysteine use among patients undergoing cardiac surgery: A systematic review and meta-analysis of randomized trials

“…Among the 29 eligible RCTs, trials took place in a variety of settings (S5 Table) including Turkey [20, 53, 54, 59, 60, 63, 66, 67, 69, 70], Canada [56, 58, 79], United States of America [52, 55], Finland [73, 78], Germany [61], Italy [75], Belgium [57], India [68, 71, 72], South Korea [65, 77], Iran [64, 76], Brazil [74] and Australia [62]. Sample sizes ranged from 18 [57] to 295 [56] participants (S5 Table).…”

“…According to the anesthetic technique, six trials [20, 59, 66, 69, 76, 78] used total intravenous anesthesia technique (TIVA), with a total of 348 participants, while 15 trials [54, 57, 60, 63, 65, 67, 68, 70–75, 77, 79] reported using inhaled anesthetics with a total of 1,203 participants. Eight trials [52, 53, 55, 56, 58, 61, 62, 64] with a total of 936 participants did not report which anesthetic technique was employed (S6 Table).…”

“…Results from 17 RCTs [52, 53, 55, 56, 58, 60, 61, 64, 65, 67–70, 73–75, 79] including 1,737 patients yielded a non-statistically significant difference between NAC and SoC on the reduction of mortality (RR 0.71, 95% CI 0.40 to 1.25; events (NAC:20/870, SoC:33/867); I 2 = 0%; p = 0.23) (Fig 2). The certainty of evidence was rated as low because of imprecision (low number of events (<400) and wide confidence intervals including clinically important benefit and harm) (Table 1) and no publication bias was detected (S2 Fig, panel A).…”

“…Clinical outcomes. Results from 15 RCTs [52–56, 58, 59, 64, 65, 68, 70, 72, 73, 75, 77] with a total of 1,711 patients for acute renal insufficiency (RR 0.92, 95% CI 0.79 to 1.09; events (NAC:180/886, SoC:193/845); I 2 = 0%; p = 0.34) (Fig 3); 12 RCTs [53, 58, 59, 61, 63, 64, 66, 67, 70, 75, 77, 78] with a total of 1,149 patients for cardiac insufficiency (RR 0.77, 95% CI 0.44 to 1.38; events (NAC:19/572; SoC:24/577); I 2 = 0%; p = 0.38) (Fig 4); 10 RCTs [53, 58–60, 62, 64, 65, 69, 70, 76] with a total of 886 patients for arrhythmia (RR 0.79, 95% CI 0.52 to 1.20; events (NAC:81/446, SoC:98/440); I 2 = 50%; p = 0.27) (Fig 5); and 11 RCTs [20, 56, 60, 61, 63, 64, 65, 67, 68, 75, 78] with a total of 1,178 patients for acute myocardial infarction (RR 0.84, 95% CI 0.48 to 1.48; events (NAC:22/587, SoC:26/591); I 2 = 0%; p = 0.55) (Fig 6) yielded a non statistically significant difference between NAC and SoC in patients submitted to cardiac surgery.…”

Cysteine and homocysteine as biomarker of various diseases

“…Some recent studies demonstrated that NAC might prevent contrast nephropathy (impairment of renal function). It has anti‐inflammatory and antioxidant effects that could prevent renal dysfunction (Aldemir et al., 2016).…”