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N-Acetylcysteine Improves Arterial Vascular Reactivity in Patients with Chronic Kidney Disease

2009; Karger Publishers; Volume: 112; Issue: 3 Linguagem: Inglês

10.1159/000218107

1660-2110

Antje Wittstock, M. Burkert, Walter Zidek, Martin Tepel, Alexandra Scholze,

Peripheral Artery Disease Management

<i>Background:</i> Patients with stage 5 chronic kidney disease show increased cardiovascular morbidity and mortality that are partly related to impaired arterial vascular reactivity. We investigated whether intravenous administration of the antioxidant acetylcysteine improves arterial vascular reactivity in these patients. <i>Methods:</i> Arterial vascular reactivity was determined during reactive hyperemia by photoplethysmography of digital pulse waves in a randomized, prospective, placebo-controlled cross-over study of 24 patients with stage 5 chronic kidney disease with and without infusion of acetylcysteine during hemodialysis. Acetylcysteine (5 g in 5% glucose in a final volume of 50 ml) was continuously administered intravenously during one hemodialysis session. <i>Results:</i> In the absence of acetylcysteine, the reflective index was 38.5 ± 9.4 (mean ± SD; n = 24) at baseline and 33.8 ± 9.9 during reactive hyperemia, immediately after the hemodialysis session; thus there was no significant vasodilatation (p > 0.05), indicating impaired arterial vascular reactivity in these patients. However, when the hemodialysis session in the same patients was performed in the presence of acetylcysteine, the reflective index significantly decreased from 37.9 ± 8.6 at baseline to 30.2 ± 10.3 during reactive hyperemia (n = 24; p < 0.01). <i>Conclusion:</i> The present study shows that intravenous administration of acetylcysteine during hemodialysis significantly improves arterial vascular reactivity during reactive hyperemia.