The effect of N-acetylcysteine on inflammatory and oxidative markers in patients receiving hemodialysis; a single-arm clinical trial study

Introduction: Oxidative stress is common in patients with chronic kidney disease, especially those that need hemodialysis. Due to the increased chance of oxidative stress and inflammation following dialysis, the risk of developing atherosclerosis and heart disease is higher in these patients. In the case of a chronic kidney disease and hemodialysis, highly sensitive C-reactive protein (hs-CRP) as a marker of inflammation and malondialdehyde (MDA) can be considered as an indicator for oxidative stress. N-acetyl cysteine (NAC) is a thiol antioxidant acting as a free radical scavenger. There are conflicting results regarding the effect of NAC on inflammation and oxidative stress. Objectives: This study was designed to evaluate the effect of this drug on hs-CRP and MDA in patients undergoing hemodialysis. Patients and Methods: This single-arm clinical trial study was performed on 26 patients receiving hemodialysis. The patients were treated with NAC 600 mg twice a day for two months. They were tested before the treatment and two months later. The data were analyzed using SPSS (version 22). Chi-square and paired T-tests were also employed for the statistical analysis of the data. Moreover, P value of <0.05 were considered statistically significant. Results: In this study, 26, out of 32, participants completed the study and were included in the final analysis. The results showed that, compared to baseline, treatment with NAC significantly reduced albumin (P=0.025) and hs-CRP (P=0.003). Moreover, supplementation with NAC significantly increased hemoglobin (P=0.005), serum iron (P=0.002), transferrin saturation (P<0.001), and calcium (P=0.026). However, no significant difference was observed at the end of the study in white blood cells (WBC; P=0.337), platelets (P=0.809), ferritin (P=0.797), calcium-phosphorus product (Ca×P; P=0.93), triglycerides (P=0.604), total cholesterol (P=0.411), low-density lipoprotein (LDL; P=0.145), high-density lipoprotein (HDL; P=1.00), and malondialdehyde (MDA; P=0.960). Conclusion: The present survey suggests that NAC may be an effective option in managing hemoglobin, serum iron, transferrin saturation, calcium, albumin, and hs-CRP in patients receiving hemodialysis. Further researches are needed to confirm the veracity of our findings. Trial Registration: The trial protocol was approved in the Iranian registry of clinical trial (identifier: IRCT2016111529812N2; https://irct.behdasht.gov.ir/trial/23866, ethical code; 17/1/257428).