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Abstract: PO1287

Effect of N-Acetylcysteine on Nontraditional Cardiovascular Risk Factors and Carotid Intimal Medial Thickness in Chronic Peritoneal Dialysis Patients

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Author

  • Mahajan, Sandeep, All India Institute of Medical Sciences, New Delhi, Delhi, India
Background

Accelerated atherosclerosis increases morbidity and mortality among PD patients. Various non-traditional risk factors (NTRFs) like oxidative stress (OS), impaired endothelial function (EF), micro-inflammation and increased homocysteine (HCS) have been implicated. N-acetyl cysteine (NAC) is an antioxidant, reduces HCS and has shown to improve EF and cardiovascular endpoints in HD patients. No study has looked at its effect on NTRFs in PD patients & its effect on structural atherosclerosis

Methods

Stable consenting patients on chronic PD (PD duration >3 months) were given oral NAC (600 mg twice daily) for 3 months. No changes were made in PD prescription. Demographic data, clinical, biochemical profile, EF, OS, HCS, highly-sensitive C-Reactive protein (Hs-CRP) and Carotid intimal medial thickness (CIMT, marker of structural atherosclerosis) were noted before and after 3 months. OS was measured by total anti-oxidant capacity (TAC) and thiobarbituric acid reactive substances (TBRAS). EF was assessed by brachial artery flow-mediated dilatation (FMD) subsequent to occlusion. CIMT of both carotids at 8 sites was assessed by high-resolution ultrasonography

Results

Of 80 patients approached by convenience sampling, 73 who completed study were analysed (2 refused consent, 5 did not follow-up at desired time). None of the patients reported any adverse events or discontinued the drug. In these patients, 28 were diabetics, 50 were males. Mean age, duration of PD and urine output: were 51.6±11.1 years, 11.6±3.2 months and 448.7±341.9 ml/day respectively. Table shows study parameters before and after NAC

Conclusion

In our open-label study NAC effectively reduced multiple NTRFs and atherosclerotic burden in PD patients. T

Parameter Pre NACPost NACP-Value
HCS (µmol/L)23.6±4.514.7±3.1<0.001
HsCRP (mg/dl)3.8±1.12.2±0.5<0.001
FMD (%)7.6±2.411.2±3.5<0.001
TBARS (nmol/ml)18.4±11.114.4±6.6<0.01
TAC (Mmol/L)1.01±0.21.14±0.30.03
CIMT (mm)0.59±0.20.48±0.1<0.001

NAC-N-acetyl cysteine ; HCS-homocysteine; HsCRP-highly-sensitive C-Reactive protein; FMD-brachial artery flow-mediated dilatation; TBARS-thiobarbituric acid reactive substances; TAC-total anti-oxidant capacity; CIMT-Carotid intimal medial thickness