American Journal of Kidney Diseases
Volume 53, Issue 1 , Pages 33-40 , January 2009

Meta-analysis of N-Acetylcysteine to Prevent Acute Renal Failure After Major Surgery

  • Kwok M. Ho, MBBS, MPH, FRCP, FANZCA, FJFICM

      Affiliations

    • Corresponding Author InformationAddress correspondence to Kwok M. Ho, MBBS, MPH, FRCP, FANZCA, FJFICM, ICU, Royal Perth Hospital, Perth, WA 6000, Australia
  • ,
  • David J.R. Morgan, MBBS, FACEM, FJFICM

Received 12 February 2008 ,Accepted 7 May 2008.

References 

  1. Barratt J, Parajasingam R, Sayers RD, Feehally J. Outcome of acute renal failure following surgical repair of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2000;20:163–168
  2. Antunes PE, Prieto D, Ferrao de Oliveira J, Antunes MJ. Renal dysfunction after myocardial revascularization. Eur J Cardiothorac Surg. 2004;25:597–604
  3. Sear JW. Kidney dysfunction in the postoperative period. Br J Anaesth. 2005;95:20–32
  4. Burns KE, Chu MW, Novick RJ, et al. Perioperative N-acetylcysteine to prevent renal dysfunction in high-risk patients undergoing CABG surgery. JAMA. 2005;294:342–350
  5. Jiang B, Haverty M, Brecher P. N-Acetyl-l-cysteine enhances interleukin-1beta-induced nitric oxide synthase expression. Hypertension. 1999;34:574–579
  6. DiMari J, Megyesi J, Udvarhelyi N, Price P, Davis R, Safirstein R. N-Acetyl cysteine ameliorates ischemic renal failure. Am J Physiol. 1997;272:F292–F298
  7. Nitescu N, Ricksten SE, Marcussen N, et al. N-Acetylcysteine attenuates kidney injury in rats subjected to renal ischaemia-reperfusion. Nephrol Dial Transplant. 2006;21:1240–1247
  8. Conesa EL, Valero F, Nadal JC, et al. N-Acetyl-l-cysteine improves renal medullary hypoperfusion in acute renal failure. Am J Physiol Regul Integr Comp Physiol. 2001;281:R730–R737
  9. Birck R, Krzossok S, Markowetz F, Schnülle P, van der Woude FJ, Braun C. Acetylcysteine for prevention of contrast nephropathy: Meta-analysis. Lancet. 2003;362:598–603
  10. Marenzi G, Assanelli E, Marana I, et al. N-Acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med. 2006;354:2773–2782
  11. Wijeysundera DN, Beattie WS, Rao V, Granton JT, Chan CT. N-Acetylcysteine for preventing acute kidney injury in cardiac surgery patients with pre-existing moderate renal insufficiency. Can J Anaesth. 2007;54:872–881
  12. Peake SL, Moran JL, Leppard PI. N-Acetyl-l-cysteine depresses cardiac performance in patients with septic shock. Crit Care Med. 1996;24:1302–1310
  13. Niemi TT, Munsterhjelm E, Pöyhiä R, Hynninen MS, Salmenperä MT. The effect of N-acetylcysteine on blood coagulation and platelet function in patients undergoing open repair of abdominal aortic aneurysm. Blood Coagul Fibrinolysis. 2006;17:29–34
  14. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560
  15. Ristikankare A, Kuitunen T, Kuitunen A, et al. Lack of renoprotective effect of i.v. N-acetylcysteine in patients with chronic renal failure undergoing cardiac surgery. Br J Anaesth. 2006;97:611–616
  16. Sisillo E, Ceriani R, Bortone F, et al. N-Acetylcysteine for prevention of acute renal failure in patients with chronic renal insufficiency undergoing cardiac surgery: A prospective, randomized, clinical trial. Crit Care Med. 2008;36:81–86
  17. Haase M, Haase-Fielitz A, Bagshaw SM, et al. Phase II, randomized, controlled trial of high-dose N-acetylcysteine in high-risk cardiac surgery patients. Crit Care Med. 2007;35:1324–1331
  18. Tossios P, Bloch W, Huebner A, et al. N-Acetylcysteine prevents reactive oxygen species-mediated myocardial stress in patients undergoing cardiac surgery: Results of a randomized, double-blind, placebo-controlled clinical trial. J Thorac Cardiovasc Surg. 2003;126:1513–1520
  19. El-Hamamsy I, Stevens LM, Carrier M, et al. Effect of intravenous N-acetylcysteine on outcomes after coronary artery bypass surgery: A randomized, double-blind, placebo-controlled clinical trial. J Thorac Cardiovasc Surg. 2007;133:7–12
  20. Hynninen MS, Niemi TT, Pöyhiä R, et al. N-Acetylcysteine for the prevention of kidney injury in abdominal aortic surgery: A randomized, double-blind, placebo-controlled trial. Anesth Analg. 2006;102:1638–1645
  21. Macedo E, Abdulkader R, Castro I, Sobrinho AC, Yu L, Vieira JM. Lack of protection of N-acetylcysteine (NAC) in acute renal failure related to elective aortic aneurysm repair—A randomized controlled trial. Nephrol Dial Transplant. 2006;21:1863–1869
  22. Molnar Z, Szakmany T, Koszegi T. Prophylactic N-acetylcysteine decreases serum CRP but not PCT levels and microalbuminuria following major abdominal surgery (A prospective, randomised, double-blinded, placebo-controlled clinical trial). Intensive Care Med. 2003;29:749–755
  23. Fischer UM, Tossios P, Huebner A, Geissler HJ, Bloch W, Mehlhorn U. Myocardial apoptosis prevention by radical scavenging in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2004;128:103–108
  24. Szakmány T, Tóth I, Márton S, Molnár Z. Effect of prophylactic N-acetylcysteine on postoperative organ dysfunction and inflammatory markers after major abdominal surgery for cancer (Prospective, randomized, double-blind, placebo-controlled clinical trial). Magy Seb. 2002;55:369–374
  25. Szakmany T, Marton S, Molnar Z. Lack of effect of prophylactic N-acetylcysteine on postoperative organ dysfunction following major abdominal tumour surgery: A randomized, placebo-controlled, double-blinded clinical trial. Anaesth Intensive Care. 2003;31:267–271
  26. Wijnen MH, Vader HL, Van Den Wall Bake AW, Roumen RM. Can renal dysfunction after infra-renal aortic aneurysm repair be modified by multi-antioxidant supplementation?. J Cardiovasc Surg (Torino). 2002;43:483–488
  27. Tepel M, van der Giet M, Schwarzfeld C, et al. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med. 2000;343:180–184
  28. Bakris GL, Lass N, Gaber AO, et al. Radiocontrast medium-induced declines in renal function: A role for oxygen free radicals. Am J Physiol. 1990;258:F115–F120

 Originally published online as doi:10.1053/j.ajkd.2008.05.019 on July 25, 2008.

PII: S0272-6386(08)00958-X

doi: 10.1053/j.ajkd.2008.05.019

American Journal of Kidney Diseases
Volume 53, Issue 1 , Pages 33-40 , January 2009