Effect of N-Acetylcysteine on Residual Renal Function in Chronic Haemodialysis Patients Treated with High-Flux Synthetic Dialysis Membranes: A Pilot Study
Background. Preservation of residual renal function in chronic dialysis patients has proven to be a major predictor of survival. The aim of the present study was to investigate an ability of the combined use of N-acetylcysteine and high-flux biocompatible haemodialysis membranes to improve residual renal function in haemodialysis patients. Patients and Methods. Chronic haemodialysis patients with a residual urine output of at least 100？mL/24？h were administered oral an N-acetylcysteine 1200？mg twice daily for 2 weeks. Treatment group included patients treated with dialysers using high-flux synthetic biocompatible membranes. Control group included patients treated with dialysers using low-flux semisyntetic triacetate haemodialysis membranes. Results. Eighteen patients participated in the study. The residual glomerular filtration rate showed a nonsignificant trend for increase in both groups. The magnitude of GFR improvement after N-acetylcysteine administration was less pronounced in the group treated with high-flux biocompatible membranes: +0.17 ± 0.56？mL/min/1.73？m2 in treatment group and +0.65 ± 0.53？mL/min/1.73？m2 in control group ( ). Conclusion. In this study of favorable effect of N-acetylcysteine on residual renal function in chronic haemodialysis patients may be less pronounced when using high-flux biocompatible, rather than low-flux semisyntetic, HD membranes. 1. Introduction Preserving residual renal function (RRF) has always been the primary clinical goal for every nephrologist managing patients with chronic kidney disease. RRF in patients of dialysis has proven to be a consistent and powerful predictor of mortality [1, 2]. This is particularly evident for patients treated with peritoneal dialysis (PD): CANUSA study showed that only RRF but not dialysis dose has significant predictive power of mortality [1]. Up till now, there have been a very few studies that have examined the contribution of RRF to outcome in haemodialysis (HD) patients [2–4]. This is particularly unfortunate because HD patients count at least 93% of all dialysis population in many different countries, such as Portugal, USA, and Israel [5]. Moreover, it is well known that RRF deteriorates more rapidly in HD patients than in PD patients [6]. Preservation of RRF remains an unresolved problem in dialysis patients. Nevertheless, several important facts may provide some hope for better maintenance of RRF in HD patients. First, using modern membranes for haemodialysis (specifically—high flux biocompatible membranes) may lead to a significantly better preservation of RRF [7].
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