Evaluating the effect of N-acetylcysteine on residual renal function in chronic hemodialysis patients treated with low-flux dialysis membrane; a randomized clinical trial

Introduction: The goal of any physician who cares about dialysis patients is to increase their quality of life. Many studies have shown that residual renal function (RRF) in dialysis patients, especially those undergoing peritoneal dialysis (PD), is an important prognostic factor for mortality. Objectives: In the present study, we aimed to investigate the effect of N-acetylcysteine (NAC) as an antioxidant on increasing RRF in chronic hemodialysis (HD) patients. Patients and Methods: Ninety-eight chronic HD patients who have urinary output greater than 100 cc in 24 hours participated in this study and were divided into two groups of treatment and control (49 patients each). Subsequently, the oral NAC treatment group received 600 mg tablets twice a day before meals. The control group received placebo tablets again twice a day before meals. The duration of the study was 4 weeks. Results: The RRF significantly improved in the treatment group during the study period, but no significant changes were observed in the control group. Residual glomerular filtration rate (GFR) rose from 1.7 ± 0.73 to 2.7 ± 1.1 mL/min/1.73 m2 (P < 0.0001) in the treatment group, while in the control group, there was a slight increase from 2.1 ± 0.94 to 2.2 ± 1.19 mL/min/1.73 m2 (P = 0.26). Additionally, the average daily volume of urine in the treatment group increased from 594 ± 436 to 953 ± 540 mL/24 h (P < 0.0001) in the treatment group and from 809 ± 573 to 771 ± 552 mL/24 h (P = 0.11) in the control group. Finally, the calculation of residual renal Kt/V per week showed an increase from 0.21 ± 0.06 to 0.31 ± 0.08 (P < 0.0001) in the treatment group and a decrease from 0.23 ± 0.08 to 0.22 ± 0.08 (P = 0.22) in the control group. Conclusion: Our study showed that a 4-week NAC treatment improves RRF in chronic HD patients.