Effect of N-Acetyl-Cysteine (NAC) Added to Fenoldopam or Dopamine on End-Tidal Carbon Dioxide and Mean Arterial Pressure at Time of Renal Artery Declamping During Cadaveric Kidney Transplantation
- 1 May 2010
- journal article
- Published by Elsevier BV in Transplantation Proceedings
- Vol. 42 (4), 1056-1060
- https://doi.org/10.1016/j.transproceed.2010.03.072
Abstract
N-acetyl-cysteine (NAC) is known to be a powerful antioxidant used to prevent renal damage. Our deceased-donor kidney transplantation protocol administered an NAC bolus at the time of declamping of the renal artery to reduce the potential oxidative damage with ischemia-reperfusion. The aim of injury this study was to compare the effects of NAC added to a continuous infusion of either fenoldopam or dopamine during kidney recipient anesthesia on mean arterial pressure (MAP) and end-tidal carbon dioxide (ECO(2)), which were assumed to be expressions of oxidative and acid-base status. One hundred forty patients undergoing deceased donor kidney transplantation were enrolled in the study. Using a standardized perioperative anesthesia protocol, the patients were divided into 4 groups: group N, receiving an NAC (50 mg/kg) bolus just before renal artery declamping (n = 40); group C, not receiving any NAC or other infusion (n = 20); group NF, same treatment as group N plus fenoldopam (0.1 microg/kg/min) continuous infusion (n = 40); and group ND, same treatment as group N plus dopamine (3 microg/kg/min) continuous infusion (n = 40). We recorded the duration of kidney cold and warm ischemia and EtCO(2) and MAP values before and after arterial declamping, as well as subjective evaluations of graft perfusion and the incidence of early or delayed graft function and adverse events. EtCO(2) was higher and MAP lower in group C compared with group N; comparing groups N, ND, and NF, the NF regimen resulted in lower EtCO(2) and higher MAP values and a greater incidence of early graft function. Subjective evaluation of graft perfusion was more favorable for groups N, ND, and NC, particularly for NF. No significant periprocedural adverse events were recorded in the groups. In our experience, the association of an NAC bolus at the time of renal artery declamping and continuous infusion of fenoldopam resulted in a minor, though non-significant, increase in EtCO(2) values, higher MAP, and greater incidence of early graft function during deceased-donor kidney transplantation compared with no NAC or NAC plus renal-dose dopamine. Further studies are necessary to better define the potential role of oxidative damage in renal ischemia- reperfusion injury, including implications for outcome, as well as the potential role of the combination of NAC plus fenoldopam as a nephroprotective and outcome-modulating regimen.Keywords
This publication has 15 references indexed in Scilit:
- Translation of remote ischaemic preconditioning into clinical practiceThe Lancet, 2009
- Correction of Metabolic Acidosis to Ameliorate Wasting in Chronic Kidney Disease: Goals and StrategiesSeminars in Nephrology, 2009
- Fenoldopam vs Dopamine as a Nephroprotective Strategy During Living Donor Kidney Transplantation: Preliminary DataTransplantation Proceedings, 2007
- N-Acetylcysteine for patients with prolonged hypotension as prophylaxis for acute renal failure (NEPHRON)*Critical Care Medicine, 2007
- Beneficial Effect of N-Acetyl-Cysteine on Renal Injury Triggered by Ischemia and ReperfusionTransplantation Proceedings, 2006
- Renal effects of N-acetylcysteine in patients at risk for contrast nephropathy: decrease in oxidant stress-mediated renal tubular injuryNephrology Dialysis Transplantation, 2004
- Oxidative stress in end-stage renal disease: an emerging threat to patient outcomeNephrology Dialysis Transplantation, 2003
- Fenoldopam mesylate blocks reductions in renal plasma flow after radiocontrast dye infusion: A pilot trial in the prevention of contrast nephropathyAmerican Heart Journal, 2002
- Pharmacokinetics of Dopamine in Healthy Male SubjectsAnesthesiology, 2000
- The effects of fenoldopam, a selective dopamine receptor agonist, on systemic and renal hemodynamics in normotensive subjectsCritical Care Medicine, 1999