What does this research mean for the field?

Prophylactic perioperative N-acetylcysteine does not reduce the incidence of acute renal injury, the need for hemodialysis, or mortality in patients undergoing cardiac surgery. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study assesses whether N-acetylcysteine can prevent acute renal injury after cardiac surgery.

June 21, 2026Open Access

Efficacy of N-acetylcysteine in preventing renal injury after heart surgery: a systematic review of randomized trials

Key Points

This study assesses whether N-acetylcysteine can prevent acute renal injury after cardiac surgery.
Systematic review of randomized controlled trials (RCTs) of N-acetylcysteine in adult cardiac surgery patients.
Search across MEDLINE, clinicaltrials.gov, and references from relevant publications.
Included 10 RCTs with 1163 patients, analyzing ARI as the primary outcome.
N-Acetylcysteine did not significantly reduce ARI incidence (35% NAC vs. 37% placebo; RR 0.91, 95% CI 0.79-1.06, P=0.24).
Overall, 3.3% of patients required haemodialysis (RR = 1.13, 95% CI 0.59-2.17) and 3% died (RR = 1.10, 95% CI 0.56-2.16).
Trend toward reduced ARI in patients with chronic kidney disease assigned to NAC (RR = 0.80, 95% CI 0.64-1.01, P=0.06).

Abstract

AIMS: The aim of this study was to assess whether perioperative N-acetylcysteine (NAC), an antioxidant, prevents acute renal injury (ARI) after cardiac surgery. METHODS AND RESULTS: We performed a systematic review of randomized controlled trials (RCTs) of NAC in adult cardiac surgery patients. The RCTs were identified by searching MEDLINE (1960-2008), clinicaltrials.gov website, and hand-searching references of relevant publications. Primary outcome was ARI (absolute increase >0.5 mg/dL or relative increase >25%, in serum creatinine from baseline within 5 days after surgery). Random effects model was used to perform a meta-analysis. Forest plots and I(2) test were used to assess heterogeneity among studies. Ten RCTs (n = 1163 patients) were included. Mean age was 70 +/- 7.4 years, 71% were male, and 66% underwent coronary artery bypass surgery. N-Acetylcysteine did not reduce ARI incidence 35% NAC vs. 37% placebo; relative risk (RR) 0.91, 95% CI 0.79-1.06, P = 0.24. Overall, 3.3% of patients required haemodialysis (NAC vs. placebo; RR = 1.13, 95% CI 0.59-2.17) and 3% died (RR = 1.10, 95% CI 0.56-2.16). There was a trend towards reduced ARI incidence among patients with baseline chronic kidney disease assigned to intravenous NAC (RR = 0.80, 95% CI 0.64-1.01, P = 0.06). CONCLUSION: This meta-analysis of RCTs showed that prophylactic perioperative NAC in cardiac surgery does not reduce ARI, haemodialysis, or death.

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