Effect of N-Acetylcysteine on Inflammatory and Biochemical Markers of Hemodialysis Patients: A Randomized Controlled Trial

  • Rozina Abasi Larki Department of Nephrology, Yasuj University of Medical Sciences, Yasuj, Iran.
  • Alireza Panahi Department of Internal Medicine, Yasuj University of Medical Sciences, Yasuj, Iran.
  • Leila Manzouri Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.
  • Moslem Sedaghattalab Mail Department of Internal Medicine, Yasuj University of Medical Sciences, Yasuj, Iran.
Acetylcysteine, Biomarkers, C-reactive protein, Interleukin-6, Renal dialysis


The oxidative stress results in atherosclerosis and cardiovascular diseases in patients receiving hemodialysis. N-acetylcysteine is a well-known antioxidant agent. There are little studies about the effect of N-acetylcysteine on patients receiving hemodialysis, and, if any, their results are inconsistent. This study, as a double-blind, randomized clinical trial, was conducted on 44 hemodialysis patients in Shahid Beheshti Hospital, Yasuj, Iran in 2015. Patients were randomly allocated into two groups, in the intervention group, N-acetylcysteine 600 mg every 12 hours for eight weeks was administered and the second group received placebo during this period every 12 hours. Blood samples were taken to measure C-reactive protein, interleukin-6 and other biochemical markers such as ferritin, albumin, and creatinine at baseline and at the end of treatment. 40 patients completed the study (21 on N-acetylcysteine, 19 on placebo), with a mean age of 60.72±17.60. There was not any significant difference between intervention and control groups in interleukin-6 (8.85±6.9 vs. 10.32±8.68, 95% CI, -3.52 to 6.46; P=0.55) and C - reactive protein (0.85±0.29 vs. 0.9±0.31, 95% CI, -.14 to .24; P=0.60). In addition, there was no significant relationship between the two groups in other biochemical markers. In this study, administering N-acetylcysteine was safe and caused a reduction in some inflammatory markers, but these changes were not significant in comparison with placebo.


Saddadi F, Alatab S, Pasha F, Ganji MR, Soleimanian T. The effect of treatment with N-acetylcysteine on the serum levels of C-reactive protein and interleukin-6 in patients on hemodialysis. Saudi J Kidney Dis Transpl. 2014;25:66-72.

Meerwaldt R, Zeebregts CJ, Navis G, Hillebrands JL, Lefrandt JD, Smit AJ. Accumulation of advanced glycation end products and chronic complications in ESRD treated by dialysis. American Journal of Kidney Diseases. 2009;53:138-50.

Shalansky SJ, Pate GE, Levin A, Webb JG. N-acetylcysteine for prevention of radiocontrast induced nephrotoxicity: the importance of dose and route of administration. Heart 2005;91:997e9.

Machado JT, Iborra RT, Fusco FB, Castilho G, Pinto RS, Machado-Lima A, et al. N-acetylcysteine prevents endoplasmic reticulum stress elicited in macrophages by serum albumin drawn from chronic kidney disease rats and selectively affects lipid transporters, ABCA-1 and ABCG-1. Atherosclerosis. 2014;237:343-52.

Dodd S, Dean O, Copolov DL, Malhi GS, Berk M. N-acetylcysteine for antioxidant therapy: pharmacology and clinical utility. Expert opinion on biological therapy. 2008;8:1955-62.

Needham E. Management of acute renal failure. Am Fam Physician. 2005;72:1739-46.

Weisbord SD, Gallagher M, Kaufman J, Cass A, Parikh CR, Chertow GM, et al. Prevention of contrast-induced AKI: a review of published trials and the design of the prevention of serious adverse events following angiography (PRESERVE) trial. Clinical Journal of the American Society of Nephrology. 2013; 8: 1618-1631.

Nolin TD, Ouseph R, Himmelfarb J, McMenamin ME, Ward RA. Multiple-dose pharmacokinetics and pharmacodynamics of N-acetylcysteine in patients with end-stage renal disease. Clinical Journal of the American Society of Nephrology. 2010; 5:1588-94.

Shimizu MH, Danilovic A, Andrade L, Volpini RA, Libório AB, Sanches TR, Seguro AC. N-acetylcysteine protects against renal injury following bilateral ureteral obstruction. Nephrology Dialysis Transplantation. 2008;23:3067-73.

Danilovic A, Lucon AM, Srougi M, Shimizu MH, Ianhez LE, Nahas WC, Seguro AC. Protective effect of N-acetylcysteine on early outcomes of deceased renal transplantation. Transplantation proceedings 2011 ; 43: 1443-1449.

Nascimento MM, Suliman ME, Silva M, Chinaglia T, Marchioro J, Hayashi SY, et al. Effect of oral N-acetylcysteine treatment on plasma inflammatory and oxidative stress markers in peritoneal dialysis patients: a placebo-controlled study. Perit Dial Int. 2010;30:336-42.

Zachwieja J, Zaniew M, Bobkowski W, Stefaniak E, Warzywoda A, Ostalska-Nowicka D, et al. Beneficial in vitro effect of N-acetyl-cysteine on oxidative stress and apoptosis. Pediatr Nephrol. 2005;20:725-31.

Renke M, Tylicki L, Rutkowski P, Larczynski W, Neuwelt A, Aleksandrowicz E, et al. The effect of N-acetylcysteine on blood pressure and markers of cardiovascular risk in non-diabetic patients with chronic kidney disease: A placebo-cotrolled, randomized, cross-over study. Medical Science Monitor. 2010;16:13-8.

Heloisa M, Shimizu M, Coimbra TM, De Araujo M, Menezes LF, Seguro AC. N-acetylcysteine attenuates the progression of chronic renal failure. Kidney international. 2005;68:2208-17.

Moist L, Sontrop JM, Gallo K, Mainra R, Cutler M, Freeman D, et al. Effect of N-acetylcysteine on serum creatinine and kidney function: results of a randomized controlled trial. American Journal of Kidney Diseases. 2010;56:643-50.

Feldman L, Shani M, Efrati S, Beberashvili I, Yakov-Hai I, Abramov E, et al. N-acetylcysteine improves residual renal function in peritoneal dialysis patients: a pilot study. Perit Dial Int. 2011;31:545-50.

How to Cite
Abasi Larki R, Panahi A, Manzouri L, Sedaghattalab M. Effect of N-Acetylcysteine on Inflammatory and Biochemical Markers of Hemodialysis Patients: A Randomized Controlled Trial. Acta Med Iran. 57(1):57-62.