Published Online
on January 19, 2004

A more recent version of this article appeared on January 27, 2004

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Submitted on June 6, 2003
Revised on October 10, 2003
Accepted on October 13, 2003

Acetylcysteine Reduces Plasma Homocysteine Concentration and Improves Pulse Pressure and Endothelial Function in Patients With End-Stage Renal Failure

Alexandra Scholze MD, Christiane Rinder , Joachim Beige MD, Reiner Riezler MD, Walter Zidek MD, and Martin Tepel MD^*

From Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Med. Klinik IV (A.S., C.R., J.B., W.Z., M.T.), Berlin, and Severi-Med (R.R.), Muenster, Germany.

^* To whom correspondence should be addressed. E-mail: Tepel{at}zedat.fu-berlin.de.

Background--Increased oxidative stress, elevated plasma homocysteine concentration, increased pulse pressure, and impaired endothelial function constitute risk factors for increased mortality in patients with end-stage renal failure.

Methods and Results--We investigated the metabolic and hemodynamic effects of intravenous administration of acetylcysteine, a thiol-containing antioxidant, during a hemodialysis session in a prospective, randomized, placebo-controlled crossover study in 20 patients with end-stage renal failure. Under control conditions, a hemodialysis session reduced plasma homocysteine concentration to 58±22% predialysis (mean±SD), whereas in the presence of acetylcysteine, the plasma homocysteine concentration was significantly more reduced to 12±7% predialysis (P<0.01). The reduction of plasma homocysteine concentration was significantly correlated with a reduction of pulse pressure. A 10% decrease in plasma homocysteine concentration was associated with a decrease of pulse pressure by 2.5 mm Hg. Analysis of the second derivative of photoplethysmogram waveform showed changes of arterial wave reflectance during hemodialysis in the presence of acetylcysteine, indicating improved endothelial function.

Conclusions--Acetylcysteine-dependent increase of homocysteine removal during a hemodialysis session improves plasma homocysteine concentration, pulse pressure, and endothelial function in patients with end-stage renal failure.

Key words: antioxidants • drugs • endothelium • risk factors

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