N-acetylcysteine’s renoprotective effect in cardiac surgery: A
systematic review and meta-analysis
Abstract
ABSTRACT Background/Objective: To examine N-acetylcysteine’s
renoprotective effect in adult cardiac surgery Methods: PubMed, Ovid
Medline, and Embase were searched for randomised controlled trials
published between January 1990 and November 2019 that investigated the
effect of N-acetylcysteine in preventing acute kidney injury in patients
undergoing cardiac surgery. Cochrane Library was searched to identify
any prior systematic review or meta-analysis. Eligibility Criteria:
Randomised controlled trials that assessed the effect of
N-acetylcysteine in comparison to placebo by measuring the incidence of
acute kidney injury. Two independent reviewers extracted the data and
assessed the risk of publication bias of included studies. Results:
Overall meta analytic estimates of all 10 included trials was
controversial, showing that N-acetylcysteine did not have a significant
effect (odds ratio: 0.84, 95% confidence interval 0.64 to 1.10).
However further meta analytic estimates comparing the dosage and timing
of NAC administered suggested that the administration of high dosages of
NAC perioperatively would have significant benefit in preventing acute
kidney injury. Conclusion: This study suggests that N-acetylcysteine
must be administered at high dosages perioperatively to have a
significant effect in reducing the incidence of acute kidney injury.
However, only one out of the 10 included trials administered NAC high
dosages perioperatively. Although it is worth noting that it is the only
included trial to show a significant benefit in reducing the incidence
of acute kidney injury (odds ratio: 0.30, 95% confidence interval 0.11
to 0.81), further studies should be conducted to confirm the
renoprotective effect of administering high dosages of NAC
perioperatively.