Selenium, Vitamin C and N-Acetylcysteine do not Reduce the Risk of Acute Kidney Injury after Off-Pump CABG: a Randomized Clinical Trial.

Shahram Amini,Hojat Naghavi Robabi,Mohammad Abbasi Tashnizi,Vida Vakili

doi:10.21470/1678-9741-2017-0071

Abstract

ObjectiveThe aim of this study was to investigate the impact of perioperative administration of N-acetylcysteine, selenium and vitamin C on the incidence and outcomes of acute kidney injury after off-pump coronary bypass graft surgery.Methods291 patients requiring elective off-pump coronary bypass graft surgery were randomized to receive either N-acetylcysteine, vitamin C and selenium 600 mg, 1500 mg, 0.5 mg, and nothing orally twice a day, respectively, from the day before to 2 days after surgery. They were assessed for the development of acute kidney injury using Acute Kidney Injury Network criteria, time of onset, its severity and duration, duration of mechanical ventilation, intensive care unit and hospital length of stay, and in-hospital mortality.Results272 patients completed the study. The total incidence of acute kidney injury was 22.1% (n=60) with 14 (20.9%), 15 (22.1%), 21 (31.8%), and 10 (14.1%) patients in the vitamin C, NAC, selenium, and control groups, respectively (P=0.096). We did not register significant differences in the incidence, the time of occurrence, the severity and the duration of acute kidney injury, as well as the duration of mechanical ventilation, the intensive care unit and hospital length of stay, and the in-hospital mortality among the four groups.ConclusionWe found that perioperative administration of N-acetylcysteine, vitamin C and selenium were not effective in preventing acute kidney injury and associated morbidity and mortality after off-pump coronary bypass graft surgery.

Highlights

Acute kidney injury (AKI) is frequently seen after cardiac surgery with dramatically increased mortality and morbidity
291 patients requiring elective off-pump coronary bypass graft surgery were randomized to receive either N-acetylcysteine, vitamin C and selenium 600 mg, 1500 mg, 0.5 mg, and nothing orally twice a day, respectively, from the day before to 2 days after surgery. They were assessed for the development of acute kidney injury using Acute Kidney Injury Network criteria, time of onset, its severity and duration, duration of mechanical ventilation, intensive care unit and hospital length of stay, and in-hospital mortality
We found that perioperative administration of N-acetylcysteine, vitamin C and selenium were not effective in preventing acute kidney injury and associated morbidity and mortality after off-pump coronary bypass graft surgery

Summary

Introduction

Acute kidney injury (AKI) is frequently seen after cardiac surgery with dramatically increased mortality and morbidity. A number of measures have been proposed to prevent the development of AKI, including maintenance of intravascular volume and adequate perfusion, and avoidance of nephrotoxic drugs[7]. Several drugs, including calcium channel blockers[8,9,10], and statins[11,12] have been used to prevent AKI after cardiac surgery, but with controversial results. Prevention of oxidative stress by antioxidants can help prevent kidney damage[13]. The beneficial role of antioxidants in prevention of AKI in different scenarios has been demonstrated in animal models[14,15,16,17] and human models[18]. Its effectiveness in preventing AKI following cardiac surgery has not been established[19,20,21]

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