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Effectiveness of N-acetylcysteine for preserving residual renal function in patients undergoing maintenance hemodialysis: multicenter randomized clinical trial

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Abstract

Background

To investigate the efficacy and safety of oral N-acetylcysteine (NAC) for preserving residual renal function in patients undergoing hemodialysis.

Methods

Randomized, multi-center, parallel-group, open-label clinical trial (Registration No. IRCT 2014071418482N1). 54 patients who have been undergoing hemodialysis for at least 3 months and had residual urine volume >100 ml/24 h were randomly allocated to NAC or no medication. Residual renal function evaluated by (1) estimated glomerular filtration rate (GFR), (2) 24 h urine volume, and (3) renal Kt/V. GFR and Kt/V was determined at baseline and after 3 months. 24 h urine volume was measured at baseline, after 1, 2, and 3 months.

Results

Intention-to-treat analysis was performed on 47 patients (NAC = 26, control = 21). GFR in patients receiving NAC improved, whereas in the control arm a decline of 1.0 ml/min/1.73 m2 was recorded (3.59 vs. 2.11 ml/min/1.73 m2, effect size = 17.0 %, p = 0.004). For 24 h urine volume, the between-group difference after 1 month was significant (669 vs. 533 ml/24 h, effect size = 15.4 %, p = 0.004). After 3 months, 24 h urine volume in the NAC arm was on average 137 ml higher than in the control group, and the difference reached near significance (673 vs. 536 ml/24 h, p = 0.072). In the follow-up visit, Kt/V was higher in the NAC arm but the difference did not reach statistical significance (0.81 vs. 0.54, p = 0.152).

Conclusion

Three months treatment with NAC appears to be effective in preserving renal function in patients undergoing hemodialysis and the medication is generally well-tolerated.

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Acknowledgments

This study was part of a MD thesis supported by Tehran University of Medical Sciences. The present study was supported by Tehran University of Medical Sciences (Grant No.) (Registration No. IRCT 2014071418482N1).

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Authors and Affiliations

  1. Nephrology Research Center, Imam Khomeni Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Farrokhlaga Ahmadi, Mahsa Abbaszadeh, Effat Razeghi, Simin Dashti Khoidaki, Mohammad Taghi Najafi & Mahboob Lessan-Pezeshki

  2. Center of Excellence in Nephrology, Tehran, Iran

    Farrokhlaga Ahmadi, Mahsa Abbaszadeh, Effat Razeghi, Simin Dashti Khoidaki, Mohammad Taghi Najafi & Mahboob Lessan-Pezeshki

  3. Department of Nephrology, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Sima Maziar

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  1. Farrokhlaga Ahmadi
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  2. Mahsa Abbaszadeh
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Correspondence to Farrokhlaga Ahmadi.

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Ahmadi, F., Abbaszadeh, M., Razeghi, E. et al. Effectiveness of N-acetylcysteine for preserving residual renal function in patients undergoing maintenance hemodialysis: multicenter randomized clinical trial. Clin Exp Nephrol 21, 342–349 (2017). https://doi.org/10.1007/s10157-016-1277-5

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  • DOI: https://doi.org/10.1007/s10157-016-1277-5

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