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Anesth Analg 2006;102:1638-1645
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000219590.79796.66

CARDIOVASCULAR ANESTHESIA

N-Acetylcysteine for the Prevention of Kidney Injury in Abdominal Aortic Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial

Marja S. Hynninen, MD, PhD, Tomi T. Niemi, MD, PhD, Reino Pöyhiä, MD, PhD, Elina I. Raininko, MD, Markku T. Salmenperä, MD, PhD, Mauri J. Lepäntalo, MD, PhD, Mikael J. Railo, MD, PhD, and Minna K. Tallgren, MD, PhD

Department of Anesthesia and Intensive Care Medicine, Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland

Address correspondence and reprint requests to Marja Hynninen Department of Anesthesia and Intensive Care Medicine Helsinki University Hospital, PO Box 340, Haartmaninkatu 4, 00029 HUS, Helsinki, Finland. Address e-mail to marja.hynninen{at}hus.fi.

In this prospective, randomized, placebo-controlled, double-blind trial we studied the effects of IV N-acetylcysteine for prevention of renal injury in patients undergoing abdominal aortic surgery. Seventy patients without previously documented renal dysfunction were randomly allocated to receive either N-acetylcysteine (150 mg/kg mixed in 250 mL of 5% dextrose infused in 20 min, followed by an infusion of 150 mg/kg in 250 mL of 5% dextrose over 24 h) or placebo. The infusion was started after the induction of anesthesia. The primary outcome measure was renal injury as measured by the increases in urinary N-acetyl-ß-d-glucosaminidase (NAG)/creatinine ratio (indicator of renal tubular injury) and urinary albumin/creatinine ratio (indicator of glomerular injury). Renal function was assessed by measuring plasma creatinine and serum cystatin C concentrations. The urinary NAG/creatinine ratio increased significantly from baseline to before crossclamp and remained increased on day 5 in both groups. The urinary albumin/creatinine ratio increased significantly from baseline to 6 h after declamping in the N-acetylcysteine group. However, the changes in the NAG/creatinine ratio and the albumin/creatinine ratio were not significantly different between the two groups. Plasma creatinine and serum cystatin C values remained unchanged during the study period in both groups. In conclusion, N-acetylcysteine did not offer any significant protection from renal injury during elective aortic operation in patients with normal preoperative renal function, and some degree of tubular injury seems to occur before aortic crossclamp.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.