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26453 - N-ACETYLCYSTEINE FOR REDUCING RENAL INJURY IN CARDIAC SURGERY

Toronto General Hospital And University of Toronto, Toronto, ONTARIO, Canada

INTRODUCTION: Acute renal failure is an important complication of cardiac surgery that is associated with increased mortality and morbidity. N-acetylcysteine (NAC) may prevent renal insufficiency after cardiac surgery by reducing free-radical-medicated renal injury and improving renal perfusion.

METHODS: Following REB approval, patients who were (1) undergoing aortocoronary-bypass and/or valve surgery under cardiopulmonary bypass (CPB) and (2) had preoperative renal insufficiency (creatinine clearance < 60 mL/min) were recruited into a randomized triple-blinded placebo-controlled singe-centre trial. Allocation was concealed through central randomization with drugs prepared by the pharmacy. Following informed consent, participants received either intravenous NAC (100 mg/kg bolus prior to CPB and 20 mg/kg infusion until 4 hours after surgery) or placebo. Participants were followed for 60 days after surgery. The primary outcome in intention-to-treat analyses was the percent 72-hour decline in creatinine clearance following surgery.

RESULTS: Between 2003 and 2005, 177 participants were randomized (88 NAC, 87 placebo). Overall, the participants were at high-risk for perioperative morbidity and mortality (mean Euroscore 5.8). Participants in the NAC arm had poorer preoperative renal function and a higher prevalence of diabetes; in contrast, individuals in the control arm were more likely to have poor ventricular function and undergo complex surgical procedures. No patients were lost to follow-up. There was a non-significant trend (P = 0.46) towards slightly improved 72-hour renal function in the NAC arm (Figure). NAC caused a significant reduction in all-cause mortality (0% versus 8%, P = 0.009). In addition, it was associated with trends toward reduced dialysis (1% versus 4%, P = 0.37), reduced atrial fibrillation (57% versus 67%, P = 0.21), and reduced postoperative inotropic requirements (16% versus 22%, P = 0.31).

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REFERENCES:

1 JAMA. 2005 294:342–350.[Abstract/Free Full Text]

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wijeysundera, D. Articles by Granton, J. Search for Related Content PubMed Articles by Wijeysundera, D. Articles by Granton, J.