Original InvestigationPathogenesis and Treatment of Kidney DiseaseMeta-analysis of N-Acetylcysteine to Prevent Acute Renal Failure After Major Surgery
Section snippets
Search Strategy
The literature search was performed on the Cochrane Controlled Trials Register (2007 issue 4), EMBASE (January 1990 to February 1, 2008), and MEDLINE databases (1966 to February 1, 2008). During the electronic database search, the following exploded MeSH terms were used: “N-acetylcysteine” or “N-acetyl-l-cysteine” with “renal failure, renal dysfunction, dialysis,” or “renal replacement therapy” with “surgery, perioperative, operation,” or “surgical patients.” The initial search results were
Study Description
Ten randomized controlled studies with a total of 1,193 adult patients undergoing high-risk surgery were considered (Fig 1).4, 11, 15, 16, 17, 18, 19, 20, 21, 22 Seven studies (1,003 patients) evaluated the effects of NAC in patients undergoing cardiac surgery,4, 11, 15, 16, 17, 18, 19 and 3 of these (508 patients) exclusively studied patients with preexisting renal impairment.11, 15, 16 Two studies (111 patients) evaluated the effects of NAC on patients undergoing abdominal aneurysm repair
Discussion
This meta-analysis shows that perioperative NAC use is not effective in reducing mortality and acute renal failure after major surgery when radiocontrast is not used.
NAC is inexpensive and potentially would be very cost-effective if it could prevent acute renal failure after major surgery. Although there is evidence to support the use of NAC to prevent radiocontrast nephropathy,9, 10 our results suggest that the beneficial effect of NAC on risk of acute renal failure does not extend to other
Acknowledgements
Support: None.
Financial Disclosure: None.
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2018, Chronic Kidney Disease, Dialysis, and Transplantation: A Companion to Brenner and Rector’s The KidneyAcute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)
2016, Anaesthesia Critical Care and Pain MedicineCitation Excerpt :Most of the prospective randomised controlled trials and 3 meta-analyses have not found any benefit associated with these agents [185–188]. The preventive or curative administration of N-acetylcysteine for AKI has not demonstrated any beneficial effect concerning the need for RRT and reductions in mortality [129,189–192]. Apart for preventing CIN, studies were performed essentially in the perioperative period of cardiovascular surgery.
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2013, Journal of Cardiothoracic and Vascular AnesthesiaRenal dysfunction and CABG
2012, Current Opinion in PharmacologyCitation Excerpt :However, NAC use could be associated with significantly increased blood loss and blood product utilization in cardiac surgery [32]. Furthermore, metaanalyses failed to show the beneficial effect of NAC on AKI after CABG and/or valvular surgery [33–35,36•]. Therefore, routine use of NAC in CABG is not recommended.
Originally published online as doi:10.1053/j.ajkd.2008.05.019 on July 25, 2008.