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

摘要

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 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.