N-Acetylcysteine for patients with prolonged hypotension as prophylaxis for acute renal failure (NEPHRON)

Jeffrey A. Komisarof, Gawain M. Gilkey, Dawn Peters, Caroline W. Koudelka, Mary M. Meyer, Stephen Smith

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

BACKGROUND: Acute renal failure is a common complication in critically ill patients and carries an increased morbidity and mortality. N-acetylcysteine is an antioxidant and anti-inflammatory agent that may counteract some of the pathophysiologic derangements in shock states. OBJECTIVE: To test whether the administration of N-acetylcysteine, compared with placebo, reduces the incidence of acute renal failure in hypotensive patients. DESIGN: Prospective, randomized, double-blinded, placebo-controlled study. SETTING: Intensive care units of a university tertiary care hospital. PATIENTS: One hundred forty-two patients with new onset (within 12 hrs) of at least ≥30 consecutive minutes of hypotension and/or vasopressor requirement. INTERVENTIONS: Patients were randomized to receive either N-acetylcysteine or placebo for 7 days, in addition to standard supportive therapy. MEASUREMENTS AND MAIN RESULTS: Patients who received N-acetylcysteine had an incidence of acute renal failure (≥ 0.5 mg/dL increase in creatinine) of 15.5%, compared with 16.9% in those receiving placebo (p = .82, not significant). There were no significant differences between treatment arms in any of the secondary outcomes examined, including incidence of a 50% increase in creatinine, maximal rise in creatinine, recovery of renal function, length of intensive care unit and hospital stay, requirement for renal replacement therapy, and mortality. Among patients receiving N-acetylcysteine, there were trends toward reduced incidence of acute renal failure in patients with baseline Sequential Organ Failure Assessment (SOFA) score >8 (p = .12), lower SOFA scores during the first 4 days of treatment (p = .28), and reduced mortality in patients 8, reduced SOFA scores during the first 4 days, and reduced mortality in patients

Original languageEnglish (US)
Pages (from-to)435-441
Number of pages7
JournalCritical Care Medicine
Volume35
Issue number2
DOIs
StatePublished - Feb 2007

Fingerprint

Acetylcysteine
Acute Kidney Injury
Hypotension
Organ Dysfunction Scores
Placebos
Creatinine
Mortality
Incidence
Intensive Care Units
Renal Replacement Therapy
Recovery of Function
Tertiary Healthcare
Tertiary Care Centers
Critical Illness
Shock
Length of Stay
Anti-Inflammatory Agents
Therapeutics
Antioxidants
Morbidity

Keywords

  • Acute renal failure
  • Creatinine
  • Hypotension
  • N-acetylcysteine
  • Oxygen free radicals
  • Sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

N-Acetylcysteine for patients with prolonged hypotension as prophylaxis for acute renal failure (NEPHRON). / Komisarof, Jeffrey A.; Gilkey, Gawain M.; Peters, Dawn; Koudelka, Caroline W.; Meyer, Mary M.; Smith, Stephen.

In: Critical Care Medicine, Vol. 35, No. 2, 02.2007, p. 435-441.

Research output: Contribution to journalArticle

Komisarof, Jeffrey A. ; Gilkey, Gawain M. ; Peters, Dawn ; Koudelka, Caroline W. ; Meyer, Mary M. ; Smith, Stephen. / N-Acetylcysteine for patients with prolonged hypotension as prophylaxis for acute renal failure (NEPHRON). In: Critical Care Medicine. 2007 ; Vol. 35, No. 2. pp. 435-441.
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