Effects of preoperative high-oral protein loading on short- and long-term renal outcomes following cardiac surgery: a cohort study.

Autor: Husain-Syed F; Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy. faeq.husain-syed@innere.med.uni-giessen.de.; Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany. faeq.husain-syed@innere.med.uni-giessen.de., Emlet DR; Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261, USA., Wilhelm J; Institute for Lung Health, Justus-Liebig-University Giessen, Ludwigstrasse 23, 35390, Giessen, Germany., Danesi TH; Department of Cardiac Surgery, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.; Division of Cardiac Surgery, Department of Surgery, College of Medicine, University of Cincinnaci, 231 Albert Sabin Way, Cincinnati, OH, 45267-0558, USA., Ferrari F; Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.; Intensive Care Unit, I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy., Bezerra P; Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy., Lopez-Giacoman S; Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy., Villa G; Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.; Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Piazza San Marco, 4, 50121, Florence, Italy., Tello K; Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.; Member of the German Centre for Lung Research, Universities of Giessen and Marburg Lung Centre, Klinikstrasse 33, 35392, Giessen, Germany., Birk HW; Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany., Seeger W; Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany.; Member of the German Centre for Lung Research, Universities of Giessen and Marburg Lung Centre, Klinikstrasse 33, 35392, Giessen, Germany.; Department of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research, Ludwigstrasse 43, 61231, Bad Nauheim, Germany., Giavarina D; Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy., Salvador L; Department of Cardiac Surgery, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy., Fuhrman DY; Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.; Departments of Critical Care Medicine and Pediatrics, Children's Hospital of University of Pittsburgh Medical Center, One Children's Hospital Way, 4401 Penn Ave, Pittsburgh, PA, 15224, USA., Kellum JA; Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261, USA., Ronco C; Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.; Department of Medicine (DIMED), Università di Padova, Via Giustiniani, 2, 35128, Padua, Italy.
Jazyk: angličtina
Zdroj: Journal of translational medicine [J Transl Med] 2022 May 10; Vol. 20 (1), pp. 204. Date of Electronic Publication: 2022 May 10.
DOI: 10.1186/s12967-022-03410-x
Abstrakt: Background: Post-cardiac surgery acute kidney injury (AKI) is associated with increased mortality. A high-protein meal enhances the renal blood flow and glomerular filtration rate (GFR) and might protect the kidneys from acute ischemic insults. Hence, we assessed the effect of a preoperative high-oral protein load on post-cardiac surgery renal function and used experimental models to elucidate mechanisms by which protein might stimulate kidney-protective effects.
Methods: The prospective "Preoperative Renal Functional Reserve Predicts Risk of AKI after Cardiac Operation" study follow-up was extended to postoperative 12 months for 109 patients. A 1:2 ratio propensity score matching method was used to identify a control group (n = 214) to comparatively evaluate the effects of a preoperative protein load and standard care. The primary endpoints were AKI development and postoperative estimated GFR (eGFR) loss at 3 and 12 months. We also assessed the secretion of tissue inhibitor of metalloproteases-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7), biomarkers implicated in mediating kidney-protective mechanisms in human kidney tubular cells that we exposed to varying protein concentrations.
Results: The AKI rate did not differ between the protein loading and control groups (13.6 vs. 12.3%; p = 0.5). However, the mean eGFR loss was lower in the former after 3 months (0.1 [95% CI - 1.4, - 1.7] vs. - 3.3 [95% CI - 4.4, - 2.2] ml/min/1.73 m 2 ) and 12 months (- 2.7 [95% CI - 4.2, - 1.2] vs - 10.2 [95% CI - 11.3, - 9.1] ml/min/1.73 m 2 ; p < 0.001 for both). On stratification based on AKI development, the eGFR loss after 12 months was also found to be lower in the former (- 8.0 [95% CI - 14.1, - 1.9] vs. - 18.6 [95% CI - 23.3, - 14.0] ml/min/1.73 m 2 ; p = 0.008). A dose-response analysis of the protein treatment of the primary human proximal and distal tubule epithelial cells in culture showed significantly increased IGFBP7 and TIMP-2 expression.
Conclusions: A preoperative high-oral protein load did not reduce AKI development but was associated with greater renal function preservation in patients with and without AKI at 12 months post-cardiac surgery. The potential mechanisms of action by which protein loading may induce a kidney-protective response might include cell cycle inhibition of renal tubular epithelial cells. Clinical trial registration ClinicalTrials.gov: NCT03102541 (retrospectively registered on April 5, 2017) and ClinicalTrials.gov: NCT03092947 (retrospectively registered on March 28, 2017).
(© 2022. The Author(s).)
Databáze: MEDLINE
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