N-acetylcysteine and fenoldopam protect the renal function of patients with chronic renal insufficiency undergoing cardiac surgery

Critical Care Medicine
Linda F Barr, Kenneth Kolodner

Abstract

To determine whether fenoldopam and N-acetylcysteine prevent renal deterioration and improve hospital outcome for patients with chronic renal insufficiency undergoing cardiac surgery. Prospective, randomized, double-blinded, placebo-controlled trial. A community hospital that is a cardiac referral center. Seventy-nine adult patients with chronic renal insufficiency (creatinine clearance < or = 40 mL/min) who underwent cardiac surgery. Group 1 received intravenous fenoldopam 0.1 microg/kg/min started at surgical induction and continued for 48 hrs. Group 2 received N-acetylcysteine 600 mg orally twice a day, from preoperative day 1 to postoperative day 1. Group 3 received both fenoldopam and N-acetylcysteine, and group 4 patients served as controls. Using multiple comparisons (analysis of variance) with change scores, and statistically adjusting for group differences in aortic cross-clamp time, use of intraoperative aprotinin, and preoperative use of statin, we found that the change in creatinine clearance from preoperative to postoperative day 3 was statistically less for group 1 (-1.47 mL/min +/- 2.06 SE, p = .0286) and for group 2 (-0.67 mL/min +/- 2.11 SE, p = .0198) and less but not quite significant for group 3 (-3.08 mL/mi...Continue Reading

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