N-acetylcysteine for chronic kidney disease: a systematic review and meta-analysis

Objective: The present study aimed to evaluate the safety and benefits of N-acetylcysteine (NAC) for chronic kidney disease (CKD) through a systematic review and meta-analysis. Methods and materials: We performed a literature search until 5 May 2020 in the CENTRAL, MEDLINE, EMBASE, CINAHL, Clinical Trials Registry Platform and CBM. Two reviewers independently identified eligible articles and extract data. The risk of bias and publication bias were evaluated in all included trials and Cochrane Collaboration's RevMan5.3 software was used for data analysis. Fifteen trials (20 articles) involving a total of 768 patients were included. Results: The summary results of the studies showed that NAC did reduce cardiovascular events among people with CKD, the RR was 0.60, and the number that needs to be treated (NNT) was 5.29. Pooled date of estimated glomerular filtration rate (eGFR) and serum creatinine (Scr) in the NAC group were better than those in the placebo group. No patients in all studies were terminated due to side effect. Subgroup analysis also showed that inflammatory cytokines and homocysteine were significantly lower in NAC group. Conclusion: These results suggested that NAC appears to be safe without obvious adverse events, which can also benefit kidney function, relieve inflammation and reduce cardiovascular events among people with CKD.