Effect of N-Acetyl Cysteine on acute kidney injury in patients with colistin used in intensive care; retrospective study

INTRODUCTION: Acute kidney injury (AKI) is a common condition in critically ill patients using intravenous colistin. Nephrotoxicity is dose-dependent and usually reversible. The protective effect of the use of N-Acetyl Cysteine (NAC) on kidney injury has been the subject of research for many years. In this study, we aimed to investigate the AKI in our patients who have used intravenous colistin in our intensive care unit with N-Acetyl Cysteine for mucolytic use.
METHODS: In the Intensive Care Unit of Ankara Oncology Hospital between June-December 2017, thirty-five patients over 18 years of age who were using colistin via intravenous route for five days and above as antimicrobial therapy were included in the study. Patients were retrospectively examined and divided into two groups according to whether they were using NAC in the mucolytic dose. Twelve patients who did not use NAC and twenty-three patients who used NAC were detected. The relationship of NAC with AKI was investigated. The data were analysed by frequency, cross-tables and Mann Whitney-U analysis in SPSS 24.0 program.
RESULTS: In twenty-six of the patients who were using colistin, AKI developed according to the criteria of KDIGO (74.3%). There was no significant difference between AKI rate, mortality rate, number of days of mechanical ventilation and ICU length of stay among the NAC group and non-NAC group. There was no relationship between eGFR level during hospitalization and development of AKI after use of colistin.
DISCUSSION AND CONCLUSION: It was found that mucolytic use of NAC was unsuccessful in inhibiting the nephropathy of the colistin. Although high doses of NAC have been shown to be protective against kidney damage in animal studies and in vitro studies, no protective effect of NAC due to colistin was observed in patients who were in intensive care.

Yoðun bakýmda kolistin kullanýlmýþ hastalarda mukolitik doz N-Asetil Sisteinin akut böbrek hasarýna etkisi; retrospektif inceleme

GÝRÝÞ ve AMAÇ: Akut böbrek hasarý (ABH) intravenöz kolistin kullanan kritik hastalarda sýklýkla görülebilen bir durumdur. Oluþan nefrotoksisite doz baðýmlýdýr ve genellikle geri dönüþümlüdür, kalýcý böbrek hasarý nadiren görülür. N-Asetil Sistein (NAC) kullanýmýnýn böbrek hasarýndan koruyucu etkisi uzun yýllardýr araþtýrýlan bir konu olmuþtur. Biz bu çalýþmada yoðun bakým ünitemizde intravenöz kolistin kullanmýþ olan hastalarýmýzda beraberinde mukolitik amaçlý NAC kullananlarda akut böbrek hasarýný incelemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Ankara Onkoloji Hastanesi Anestezi Yoðun Bakým Ünitesi’nde Haziran-Aralýk 2017 tarihleri arasýnda antimikrobiyal tedavi olarak intravenöz yoldan beþ gün ve üzeri kolistin kullanan 18 yaþ üzeri otuz beþ hasta çalýþmaya alýndý. Hastalar mukolitik dozda NAC kullanýp kullanmamalarýna göre retrospektif olarak incelendi ve iki gruba ayrýldý. NAC kullanan yirmi üç hasta kullanmayan on iki hasta tespit edildi. Mukolitik dozda kullanýlan NAC’ýn akut böbrek hasarý ile iliþkisi incelendi. Elde edilen veriler SPSS 24.0 programýnda frekans, çapraz tablolar ve Mann Whitney-U analizleri ile deðerlendirildi.
BULGULAR: Kolistin kullanan hastalarýn yirmi altýsýnda KDIGO kriterlerine göre ABH geliþti (%74,3). NAC kullanan ve kullanmayan grup arasýnda ABH oluþma oraný, mortalite oraný, mekanik ventilatör gün sayýsý, yoðun bakým yatýþ süresi arasýnda fark bulunamadý. Yatýþ sýrasýndaki eGFR düzeyi ile kolistin kullanýmý sonrasý ABH geliþimi arasýnda iliþki bulunamadý.
TARTIÞMA ve SONUÇ: Bu retrospektif çalýþmada mukolitik amaçlý NAC kullanýmýnýn kolistin nefropatisini engellemede baþarýsýz olduðu bulundu. Hayvan çalýþmalarýnda ve in vitro çalýþmalarda yüksek doz NAC’ýn kolistinin böbrek hasarý etkisinden koruyuculuðu gösterilmiþ olmasýna raðmen, yoðun bakýmda yatmakta olan hastalarda mukolitik dozda kullanýlan NAC’ýn kolistine baðlý oluþan ABH’dan koruyucu etkisi görülmedi.