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

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

Research output: Contribution to journalArticle

32 Scopus citations

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 <65 yrs of age (p = .20). CONCLUSIONS: There were no significant differences in any of our primary or secondary end points between patients treated with N-acetylcysteine or placebo. Trends toward reduced incidence of acute renal failure in patients with baseline SOFA score >8, reduced SOFA scores during the first 4 days, and reduced mortality in patients <65 yrs of age are provocative but require further study to determine their clinical significance.

Original languageEnglish (US)
Pages (from-to)435-441
Number of pages7
JournalCritical care medicine
Volume35
Issue number2
DOIs
StatePublished - Feb 1 2007

Keywords

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

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'N-Acetylcysteine for patients with prolonged hypotension as prophylaxis for acute renal failure (NEPHRON)'. Together they form a unique fingerprint.

  • Cite this