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European Heart Journal Advance Access published online on March 11, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp053
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Published by Oxford University Press on behalf of the European Society of Cardiology 2009

Efficacy of N-acetylcysteine in preventing renal injury after heart surgery: a systematic review of randomized trials

A. Selcuk Adabag1,*, Areef Ishani2, Hanna E. Bloomfield3, Anita K. Ngo3 and Timothy J. Wilt3

1 Division of Cardiology (111 C), Minneapolis Veterans Affairs Medical Center, The Minneapolis VA Center for Chronic Disease Outcomes Research, and the University of Minnesota, One Veterans Drive, Minneapolis, MN 55417, USA
2 Division of Nephrology, Minneapolis Veterans Affairs Medical Center, The Minneapolis VA Center for Chronic Disease Outcomes Research, and the University of Minnesota, Minneapolis, MN, USA
3 Division of General Internal Medicine, Minneapolis Veterans Affairs Medical Center, The Minneapolis VA Center for Chronic Disease Outcomes Research, and the University of Minnesota, Minneapolis, MN, USA

Received 30 August 2008; revised 10 January 2009; accepted 23 January 2009 * Corresponding author. Tel: +1 612 467 3662, Fax: +1 612 727 5668, Email: adaba001{at}umn.edu

Aims: The aim of this study was to assess whether perioperative N-acetylcysteine (NAC), an antioxidant, prevents acute renal injury (ARI) after cardiac surgery.

Methods and results: We performed a systematic review of randomized controlled trials (RCTs) of NAC in adult cardiac surgery patients. The RCTs were identified by searching MEDLINE (1960–2008), clinicaltrials.gov website, and hand-searching references of relevant publications. Primary outcome was ARI (absolute increase >0.5 mg/dL or relative increase >25%, in serum creatinine from baseline within 5 days after surgery). Random effects model was used to perform a meta-analysis. Forest plots and I2 test were used to assess heterogeneity among studies. Ten RCTs (n = 1163 patients) were included. Mean age was 70 ± 7.4 years, 71% were male, and 66% underwent coronary artery bypass surgery. N-Acetylcysteine did not reduce ARI incidence [35% NAC vs. 37% placebo; relative risk (RR) 0.91, 95% CI 0.79–1.06, P = 0.24]. Overall, 3.3% of patients required haemodialysis (NAC vs. placebo; RR = 1.13, 95% CI 0.59–2.17) and 3% died (RR = 1.10, 95% CI 0.56–2.16). There was a trend towards reduced ARI incidence among patients with baseline chronic kidney disease assigned to intravenous NAC (RR = 0.80, 95% CI 0.64–1.01, P = 0.06).

Conclusion: This meta-analysis of RCTs showed that prophylactic perioperative NAC in cardiac surgery does not reduce ARI, haemodialysis, or death.

Key Words: Cardiac surgery • Kidney • Antioxidants • Meta-analysis • Mortality


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The effect of N-acetylcysteine after cardiac surgery might be influenced by concomitant medication
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European Heart Journal, 26 Nov 2009 [Full text]

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