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Meta-analysis of N-Acetylcysteine to prevent acute renal failure after major surgery

Ho, K.M. and Morgan, D.J.R. (2009) Meta-analysis of N-Acetylcysteine to prevent acute renal failure after major surgery. American Journal of Kidney Diseases, 53 (1). pp. 33-40.

Link to Published Version: http://dx.doi.org/10.1053/j.ajkd.2008.05.019
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Abstract

Background: Acute renal failure after major surgery is associated with significant mortality and morbidity that theoretically may be attenuated by N-acetylcysteine.

Design: Meta-analysis of relevant studies sourced from the Cochrane Controlled Trial Register (2007 issue 4), EMBASE, and MEDLINE databases (1966 to February 1, 2008) without language restriction.

Setting & Population: Adult patients undergoing major surgery without the use of radiocontrast.

Selection Criteria for Studies: Randomized controlled studies comparing N-acetylcysteine with a placebo perioperatively.

Data Analysis: Categorical variables are reported as odds ratio (OR) with 95% confidence interval (CI), and continuous variables are reported as weighted-mean-difference (WMD) with 95% CI.

Outcome Measures: Effects of N-acetylcysteine on mortality and acute renal failure requiring dialysis were the main outcomes of interest. Additional outcome measures included an incremental increase in serum creatinine concentration greater than 25% above baseline, surgical reexploration for bleeding, amount of allogeneic blood transfusion, and length of intensive care unit stay.

Results: 10 studies involving a total of 1,193 adult patients undergoing major surgery were considered. N-Acetylcysteine use was not associated with a decrease in mortality (OR, 1.05; 95% CI, 0.58 to 1.92), acute renal failure requiring dialysis (OR, 1.04; 95% CI, 0.45 to 2.37), incremental increase in serum creatinine concentration greater than 25% above baseline (OR, 0.84; 95% CI, 0.64 to 1.11), or length of intensive care unit stay (WMD in days, 0.46; 95% CI, -0.43 to 1.36). N-Acetylcysteine did not appear to increase the risk of surgical reexploration for bleeding (OR, 1.16; 95% CI, 0.57 to 2.38) or amount of allogeneic blood transfusion required (WMD in units, 0.31; 95% CI, -0.21 to 0.84).

Limitations: Most studied patients had cardiac surgery and normal renal function preoperatively.

Conclusions: There is no current evidence that N-acetylcysteine used perioperatively can alter mortality or renal outcomes when radiocontrast is not used.

Publication Type: Journal Article
Publisher: Elsevier
Copyright: © 2008 National Kidney Foundation, Inc
URI: http://researchrepository.murdoch.edu.au/id/eprint/34281
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