ORIGINAL ARTICLES   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2004 December;163(6):233-8

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English

Acetycysteine: an adjunct for renal protection in thoracoabdominal aneurysm repair

Cinà C. S. ¹, Jhirad R. ¹, Laganà A. ¹, Hashem M. ², Clase C. M. ³

¹ Division of Vascular Surgery, McMaster University, Hamilton, Canada; ² Department of Anaesthesia, McMaster University, Hamilton, Canada; ³ Division of Nephrology, McMaster University, Hamilton, Canada

Aim. Free rad­i­cals ­formed as the re­sult of is­chem­ic re­per­fu­sion in­ju­ry con­trib­ute to re­nal dam­age in thor­a­coab­dom­i­nal aneu­rysm (­TAAA) re­pair. The ob­jec­tive of ­this ­study was to ­test the ef­fec­tive­ness of N-ac­e­tyl­cys­teine (NAC), a ­free rad­i­cal scav­en­ger, in re­duc­ing re­nal dys­func­tion in ­these pa­tients.
Methods. A co­hort of 20 con­sec­u­tive pa­tients under­go­ing ­TAAA re­pair rep­re­sent­ed the treat­ment ­group. NAC, 600 mg, was ad­min­is­tered per os or iv ­twice dai­ly the day be­fore and the day of sur­gery. Data re­gard­ing ­urea, crea­ti­nine, ­urine out­put, co­inter­ven­tions and re­nal func­tion ­were col­lect­ed pros­pec­tive­ly. The con­trol ­group was a ret­ro­spec­tive co­hort of 20 con­sec­u­tive pa­tients. Emergency and tho­rac­ic an­eu­rysms ­were ex­clud­ed. A ­left ven­tric­u­lar as­sist de­vice (­LVAD) was ­used for ­TAAA ­type I, II and III, and the clam­pand-go tech­nique for ­type IV (Crawford clas­sifi­ca­tion). A 40% in­crease in crea­ti­nine ­between base­line and post­op­er­a­tive day 3 was the pri­mary out­come. Secondary out­comes ex­plored di­al­y­sis re­quire­ments and the ­change in crea­ti­nine at ­days 3, 6 and 7 post­op­er­a­tive­ly.
Results. The NAC and the con­trol ­groups ­were ­matched for ex­tent of aneu­rysm. Age, sex, and co­mor­bid­ities ­were sim­i­lar in the 2 ­groups. No sta­tis­ti­cal­ly sig­nif­i­cant dif­fer­ence was ob­served in the pri­mary out­come (ab­so­lute ­risk re­duc­tion [ARR] 20%; 95% Confidence Interval 6-44%; P=0.34). The dif­fer­ence in the ab­so­lute val­ue of ser­um crea­ti­nine at base­line and at day 3 and day 7 ­between the 2 ­groups did not ­reach sta­tis­ti­cal sig­nif­i­cance, but dis­played a ­trend to­ward low­er val­ues in the treat­ment ­group at day 7 (P=0.06). Serum crea­ti­nine lev­el meas­ured at ­peak and ­days 3, 6, and 7, ­show ­that crea­ti­nine ris­es af­ter sur­gery ­with an ef­fect ­which is sta­tis­ti­cal­ly sig­nif­i­cant by re­peat­ed meas­ure anal­y­sis of var­i­ance (P<0.0001). The ­time NAC treat­ment inter­ac­tion is al­so sig­nif­i­cant (P=0.029), sug­gest­ing a pro­tec­tive ef­fect of treat­ment ­with re­spect to the ex­pect­ed ­rise in ser­um crea­ti­nine. The ARR of tem­po­rary or chron­ic di­al­y­sis as­so­ciat­ed ­with NAC did not ­reach sta­tis­ti­cal sig­nif­i­cance (ARR 20%; P=0.12).
Conclusion. NAC is prom­is­ing as a re­nop­ro­tec­tive ­agent in ­TAAA re­pair. Further ran­dom­ized stud­ies are need­ed.