Related Experiment Video
Updated: Mar 25, 2026
Acetylcholine Re-Challenge After Intracoronary Nitroglycerine Administration
Published on: April 4, 2022
N-Acetyl Cysteine Therapy Does Not Prevent Renal Failure in High-Risk Patients Undergoing Open-Heart Surgery
Abeer M Rababa'h1, Salil V Deo2, Salah E Altarabsheh3
1Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
Insights
N-acetyl cysteine (NAC) did not prevent acute kidney injury after cardiac surgery. This meta-analysis found no significant benefit of NAC in reducing renal dysfunction or mortality in high-risk patients.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Postoperative renal dysfunction is a frequent complication following cardiovascular surgery.
- The efficacy of N-acetyl cysteine (NAC) in preventing this complication remains controversial.
- This meta-analysis evaluates NAC's protective role against acute kidney dysfunction post-cardiac surgery.
Purpose of the Study:
- To assess the effectiveness of N-acetyl cysteine in preventing acute renal dysfunction after cardiac surgery.
- To analyze the impact of NAC on key clinical outcomes including renal function, mortality, and hospital stay.
Main Methods:
- A systematic search of multiple databases for randomized controlled trials comparing NAC with placebo.
- Inclusion of trials involving human patients undergoing cardiac surgery.
- Analysis of endpoints such as acute renal failure incidence, need for hemodialysis, early mortality, hospital stay duration, and creatinine level changes.
Main Results:
- Thirteen randomized trials with 713 patients in the NAC group and 707 in the control group were analyzed.
- The incidence of acute renal dysfunction was 23% with NAC versus 36% in controls, but this difference was not statistically significant in high-risk patients (RD -0.03; P = .22).
- No significant differences were observed in maximal creatinine change, early mortality, or hospital stay duration between the NAC and control groups.
Conclusions:
- Prophylactic administration of N-acetyl cysteine does not significantly reduce the incidence of renal dysfunction in high-risk patients undergoing cardiac surgery.
- Current evidence does not support the routine use of NAC for preventing acute kidney injury in this patient population.
- Further research may be needed to identify specific subgroups that could benefit from NAC therapy.
Background:
Renal dysfunction is a common complication after cardiovascular surgery. Controversial issues have been discussed regarding the role of N-acetyl cysteine in the prevention of postoperative renal dysfunction. The purpose of this meta-analysis is to assess whether N-acetyl cysteine offers any protection against the development of acute renal dysfunction after cardiac surgery.
Methods:
Multiple databases were searched for randomized trials comparing the role of N-acetyl cysteine and placebo in human patients undergoing cardiac surgery. End-points studied were: the incidence of acute renal failure, hemodialysis, early mortality, duration of hospital stay, and maximal change in creatinine values. Dichotomous variables were compared using the risk difference (RD) calculated with inverse weighting; continuous data was pooled as (standardized) mean difference. Results are presented with 95% confidence interval (P < .05 is significant); results are presented within 95% confidence interval.
Results:
Thirteen randomized trials (713 and 707 patients in the N-acetyl cysteine and control groups, respectively) were included in the present analysis; nine dealing with patients at high-risk for acute renal failure. The incidence of postoperative acute renal dysfunction was 23% and 36% in the N-acetyl cysteine and control cohorts, respectively. N-acetyl cysteine therapy did not reduce acute renal dysfunction in the high-risk cohort [RD -0.03 (-0.09 to 0.02); P = .22; I2 = 24%]. Maximal change in creatinine levels after surgery was also comparable [standardized mean difference 0.07 (-0.23, 0.09); P = .39]. Early mortality was 2.9% and 3.7% in the N-acetyl cysteine and control cohorts respectively; [RD 0 (-0.03 to 0.02); P = .63; I2 = 20%]. Hospital stay (mean length of stay 10.4 and 10.1 days in the N-acetyl cysteine and control cohorts, respectively) was also similar in both cohorts [WMD 0.17 (-0.02 to 0.37) days; P = .81].
Conclusion:
Prophylactic N-acetyl cysteine therapy does not reduce the incidence of renal dysfunction in high-risk patients undergoing cardiac surgery.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management
01:30Acute Coronary Syndrome I: Introduction
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies