N-acetylcysteine for treatment of anemia in children with kidney failure: a prospective study

Abstract Background and purpose Chronic kidney disease (CKD) results from irreversible kidney damage and is primarily linked to glomerular diseases and congenital anomalies in children. Patients with CKD experience increased oxidative stress. N-acetyl cysteine (NAC) is a synthetic form of cysteine that breaks down into glutathione, which acts as an antioxidant. This study aimed to evaluate the effects of NAC on hematological and cardiac indices in children with kidney failure undergoing hemodialysis. Methods This prospective study included 48 children with kidney failure who were on maintenance hemodialysis. Six patients were subsequently excluded because of drug intolerance. The study gathered data on the original cause of CKD, initiation of hemodialysis, weight, height, and BMI. Initial and follow-up assessments included blood count, calcium profile, iron profile, markers of oxidative stress, and 2-D echocardiography to evaluate cardiac contractility and LV diameters. All participants were given oral NAC daily for 3 months. Results The average age of the patients was 10.2 ± 3.35 years, and the average duration of dialysis was 3.9 ± 2.87 years. Our research revealed that NAC has strong antioxidant properties. This was shown by a significant increase in total antioxidant capacity (TAC) and a notable decrease in total oxidative stress (TOS) after 3 months of NAC administration. NAC was also found to improve anemia in the participants, as demonstrated by a significant increase in hemoglobin levels after treatment compared with the baseline measurements in the current study. Additionally, a significant reduction in ferritin levels was observed after 3 months of administration of NAC. Furthermore, we discovered that NAC has a protective effect against cardiovascular disorders associated with CKD, as evidenced by the significant improvement in the LV diameter and cardiac contractility. Conclusion NAC can improve anemia and cardiac function, and reduce oxidative stress in children with kidney failure undergoing maintenance hemodialysis.