Dextran‐based priming solution during cardiopulmonary bypass attenuates renal tubular injury—A secondary analysis of randomized controlled trial in adult cardiac surgery patients.

Autor: Kolsrud, Oscar, Barbu, Mikael, Dellgren, Göran, Björk, Kerstin, Corderfeldt, Anna, Thoren, Anders, Jeppsson, Anders, Ricksten, Sven‐Erik
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Zdroj: Acta Anaesthesiologica Scandinavica; Jan2022, Vol. 66 Issue 1, p40-47, 8p, 3 Charts, 1 Graph
Abstrakt: Background: Acute kidney injury (AKI) is a well‐known complication after cardiac surgery and cardiopulmonary bypass (CPB). In the present secondary analysis of a blinded randomized controlled trial, we evaluated the effects of a colloid‐based versus a conventional crystalloid‐based prime on tubular injury and postoperative renal function in patients undergoing cardiac surgery with CPB. Methods: Eighty‐four adult patients undergoing cardiac surgery with CPB were randomized to receive either a crystalloid‐ or colloid‐ (dextran 40) based CPB priming solution. The crystalloid solution was based on Ringer‐Acetate plus mannitol. The tubular injury biomarker, N‐acetyl‐b‐D‐glucosaminidase (NAG), serum creatinine and diuresis were measured before, during and after CPB. The incidence of AKI was assessed according to the KDIGO criteria. Results: The urinary‐NAG/urinary‐creatinine ratio rose in both groups during and after CPB, with a more pronounced increase in the crystalloid group (p =.038). One hour after CPB, the urinary‐NAG/urinary‐creatinine ratio was 88% higher in the crystalloid group (4.7 ± 6.3 vs. 2.5 ± 2.7, p =.045). Patients that received the dextran 40‐based priming solution had a significantly lower intraoperative diuresis (p <.001) compared to the crystalloid group. The incidence of AKI was 18% in the colloid and 22% in the crystalloid group (p =.66). Postoperative serum creatinine did not differ between groups. Conclusions: In patients undergoing cardiac surgery with CPB, colloid‐based priming solution (dextran 40) induced less renal tubular injury compared to a crystalloid‐based priming solution. Whether a colloid‐based priming solution will improve renal outcome in high‐risk cardiac surgery, or not, needs to be evaluated in future studies on higher risk cardiac surgery patients. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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