Effect of N-Acetylcysteine on Endothelial Dysfunction in Dialysis Patients

• Published in: Blood purification Vol. 25; no. 4; pp. 309 - 315
• Main Authors: Sahin, Garip, Yalcin, Ahmet Ugur, Akcar, Nevbahar
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.01.2007
• Subjects: Acetylcysteine - pharmacology; Acetylcysteine - therapeutic use; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antioxidants - pharmacology; Antioxidants - therapeutic use; Biological and medical sciences; Brachial Artery - diagnostic imaging; Brachial Artery - drug effects; Brachial Artery - physiopathology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Emergency and intensive care: renal failure. Dialysis management; Endothelium, Vascular - drug effects; Endothelium, Vascular - physiopathology; Female; Glomerulonephritis; Hemorheology; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Nitric Oxide - physiology; Nitroglycerin; Original Paper; Oxidative Stress - drug effects; Renal Dialysis; Ultrasonography; Uremia - blood; Uremia - therapy; Vasodilation - drug effects; Endothelial dysfunction; Oxidative stress; Chronic kidney disease; Antioxidant; N-acetylcysteine; Human; Kidney disease; Thiol; Urinary system disease; Hemodialysis; Acetylcysteine; Mucolytic; Dialysis
• ISSN: 0253-5068; 1421-9735
• DOI: 10.1159/000106103

Background/Aims: Patients with K/DOQI stage 5 chronic kidney disease (CKD) have higher incidence of cardiovascular events due to the oxidative stress and endothelial dysfunction (ED). The aim of this study is to evaluate the effects of N-acetylcysteine (NAC), which might prevent cardiovascular events by improving oxidative stress on endothelial cells in patients with CKD. Methods: Thirty uremic patients (age 40 ± 12 years, 6 males) on hemodialysis (HD) were evaluated for ED by using high-resolution Doppler ultrasound of brachial artery before and after 6 weeks of oral NAC (2 × 600 mg) medication. Also, 13 healthy controls (35 ± 9 years, 5 males) were included in the study. Reactive hyperemia following 5 min forearm ischemia was accepted as endothelium-dependent vasodilatation (flow-mediated dilatation; FMD) and compared to endothelium-independent vasodilatation in response to sublingual glyceril trinitrate (GTN). Results: Patients on HD had lower ΔFMD (0.28 ± 0.17 vs. 0.41 ± 0.11, p < 0.05) and FMD% (7.5 ± 5.05 vs. 11.33 ± 2.95, p < 0.05) than the controls. Baseline ΔGTN and GTN% were similar in two groups. NAC treatment significantly increased the ΔFMD (0.41 ± 0.11, p < 0.001 vs. baseline) and FMD% (10.59 ± 3.22, p < 0.01 vs. baseline) of patients on HD, while it had no effect on ΔGTN and GTN%. Conclusion: These results suggest that NAC treatment could improve the ED by preventing the reduction of FMD in patients on HD.