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. 2016 Jul;16(7):504-511.
doi: 10.5152/AnatolJCardiol.2015.6287. Epub 2015 Nov 25.

Effects of N-acetyl cysteine on renal functions evaluated by blood neutrophil gelatinase-associated lipocalin levels in geriatric patients undergoing coronary artery bypass grafting

Mustafa Aldemir  1 , Halit Buğra Koca  2 , Elif Doğan Bakı  3 , Görkem Çarşanba  4 , Nilgün Öztürk Kavrut  5 , Ali Sait Kavaklı  5 , Fahri Adalı  4 , Mustafa Emmiler  6 , Osman Tansel Darçın  4
Affiliations

Effects of N-acetyl cysteine on renal functions evaluated by blood neutrophil gelatinase-associated lipocalin levels in geriatric patients undergoing coronary artery bypass grafting

Mustafa Aldemir et al. Anatol J Cardiol. 2016 Jul.

Abstract

Objective: Recent conflicting studies on the renal effects of N-acetyl cysteine (NAC) after cardiac surgery have been published. The aim of this study was to evaluate the renal effects of NAC using neutrophil gelatinase-associated lipocalin (NGAL) blood levels in elderly patients undergoing coronary artery bypass grafting (CABG).

Methods: This randomized, double-blinded, placebo-controlled study was conducted among geriatric patients (>65 years) scheduled to undergo CABG. A total of 60 consecutive patients were randomly assigned to 2 groups. The first group received I.V. NAC (n=30) and the second group received placebo (n=30) at induction of anesthesia and then for 20 h. NGAL values were determined and conventional renal function tests were performed. Statistical analysis was performed using SPSS 17.0 (IL, Chicago, USA). A p value of <0.05 was considered statistically significant.

Results: Plasma creatinine levels at 24 h postoperatively were significantly higher in the placebo group than in the NAC group (1.41±0.63 vs. 1.13±0.35; p<0.05). The mean serum NGAL levels at 3 h postoperatively were higher in the placebo group than in the NAC group (104.94±30.51 vs. 87.82±25.18; p<0.05). NGAL levels were similar between the groups at all other measurement time points. Plasma creatinine levels of ≥1.5 mg/dL or >25% of the baseline value at any time during the study period were observed in 27% of patients in the NAC group and 37% of patients in the placebo group; the difference was statistically significant (p<0.05).

Conclusion: In the present study, we found that I.V. NAC infusion in elderly patients undergoing CABG reduced the incidence of acute kidney injury as determined by blood NGAL and creatinine levels.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Flow diagram of the study participants
Figure 2
Figure 2
Plasma creatinine levels at T0 (baseline), T1 (3 h postoperatively), T2 (12 h postoperatively), T3 (postoperative day 1), and T4 (postoperative day 2); *: P<0.05
Figure 3
Figure 3
Serum NGAL levels at T0 (baseline), T1 (3 h postoperatively), T2 (12 h postoperatively), and T3 (24 h postoperatively). Student’s t-test was used for the comparison of groups; *: P<0.05
Figure 4
Figure 4
Estimated glomerular filtration rate (eGFR) at T0 (baseline), T1 (3 h postoperatively), T2 (12 h postoperatively), T3 (postoperative day 1), and T4 (postoperative day 2). Student’s t-test was used for the comparison of groups; *: P<0.05
Figure 5
Figure 5
Intraoperative hemodynamic parameters. MAP, mean arterial pressure; HR, heart rate; SaO2, oxygen saturation; CVP, central venous pressure; *: P<0.001
See this image and copyright information in PMC

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