Murdoch University Research Repository

Welcome to the Murdoch University Research Repository

The Murdoch University Research Repository is an open access digital collection of research
created by Murdoch University staff, researchers and postgraduate students.

Learn more

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
*Subscription may be required

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.

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