N-acetylcysteine for renal protection in patients with rheumatic heart disease undergoing valve replacement
Fatma A Abd El Aal, Mostafa S Abbas
Department of Anesthesia and Intensive care, Faculty of Medicine, Assiut University, Assiut, Egypt
Fatma A Abd El Aal
MD, Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, 71526 Assuit
Source of Support: None, Conflict of Interest: None
Acute kidney injury (AKI) after cardiac surgery is associated with increased morbidity and mortality. The aim of the study is to assess the effect of N-acetylcysteine (NAC) on postoperative AKI in patients with rheumatic heart disease undergoing valve replacement while excluding other risk factors (clinical trials gov identifier NCT01704482).
Patients and methods
In this prospective, randomized, placebo-controlled, double-blinded clinical trial, conducted in Assiut University Hospital, 60 patients with rheumatic valvular heart disease who underwent heart surgery were randomized to either group N (n=30) 24 h of high dose N-acetylcysteine infusion (300 mg/kg body weight in 5% glucose) or group C (n=30) equivalent volume of 5% glucose over the same period. The primary outcome was maximum change in creatinine from baseline within 5 days after surgery. The secondary outcome and other data collected were: operative time, bypass time, clamping time, intraoperative urine output, invasive mean arterial blood pressure (5 min after induction, before going on bypass, lowest on bypass and before discharge to ICU), colloids and crystalloids given at the first 24 h, blood products given in the first 48 h, furosemide for the first 48 h, urine output for the first 48 h post-operatively, duration of mechanical ventilation, length of ICU stay and hospital stay.
Creatinine increased in both groups (32.26±29 μmol/l in group N vs. 39.97±29.38 μmol/l in group C, P=0.32) and peaked on postoperative day 3. Acute kidney injury occurred in 25 patients (9 patients in group N vs. 16 patients in group C; P=0.07). There was no difference in lengths of stay in the intensive care unit, hospital stay, and duration of mechanical ventilation. There were no significant differences between both groups as regard operative time, bypass time, clamping time, intraoperative urine output, invasive mean arterial blood pressure, colloids and crystalloids given at the first 24 h, blood products given in the first 48 h, furosemide for the first 48 h and urine output for the first 48 h post-operatively.
NAC was no more effective than placebo in decreasing acute renal dysfunction in patients with Rheumatic Heart disease undergoing valve replacement.