Oral N-acetylcysteine (NAC) supplementation may be a promising adjuvant treatment for uremic anemia and oxidative stress in hemodialysis (HD) patients, researchers say.

Chiang-Ting Chien, PhD, of National Taiwan University Hospital in Taipei, and colleagues studied 325 HD patients, of whom 49 received NAC 200 mg orally three times daily during the first three months of the four-month study. The other 276 patients did not take the medication. The fourth month was a wash-out period.

With respect to anemia, the researchers defined a positive outcome as a rise of at least 3 in hematocrit and/or a reduction of at least 30% in erythropoietin dosage at month 3 compared with baseline.

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Eleven patients receiving NAC withdrew but had no severe adverse effects, whereas 49 patients not taking NAC had negative confounding events. Thus, the researchers analyzed data from 38 patients in the NAC group and 227 in the non-NAC group.

At baseline, both groups had similar average hematocrits. Throughout the study, the non-NAC group had no significant change in hematocrit levels, according to findings published in Nephron Clinical Practice (2010;116:c207-c216). In contrast, the NAC group had significant increases: The average increase was 1.7 above baseline at month 3. After the one-month wash-out, the average increase in hematocrit of 1.5 was still marginally significant. The NAC group had a larger proportion of patients with positive outcomes than the non-NAC group (16/22 vs. 49/178). Neither group had significant changes in erythropoietin dosage.

In addition, the increase in hematocrit in the NAC group was accompanied by a decrease in plasma levels of 8-isoprostane—a marker of oxidative stress—and oxidized low-density lipoprotein.