Effect of intravenous N-acetylcysteine on plasma total homocysteine and inflammatory cytokines during high flux hemodialysis

Objective: Hyperhomocysteinemia and increased inflammatory cytokines are independent risk factors in patients with renal diseases. N-acetylcysteine (NAC) is an antioxidant that is known to decrease inflammatory cytokines and plasma total homocysteine (tHcy). Therefore, the aim of this study was to compare normal saline injection with and without intravenous NAC during hemodialysis (HD) in terms of changes in serum levels of tumor necrosis factor-α (TNF-α, interleukin-10 (IL-10), high-sensitivity C-reactive protein (hs-CRP) and plasma tHcy. Patients and Methods: In total, 43 high flux HD patients were enrolled at a 4-hour HD session and split into two groups, NAC (n = 22) and NS (n = 21) treatment groups, which received either a normal saline injection with intravenous NAC or without intravenous NAC, respectively. The NS group was divided into two subgroups, one with residual renal function (n = 5) and the other with anuria (n 16). The NAC group was also divided into two subgroups, one with residual renal function (n 6) and the other with anuria (n = 16). Serum TNF-α, IL-10, hs-CRP and tHcy were measured before and immediately after HD. Results: There were no significant differences in baseline characteristics, TNF-α, IL-10, hs-CRP, and tHcy levels in intra- and intergroup comparisons. Compared to pre-HD baseline values, plasma tHcy level was lower after HD in the NS group (p