Renal Function and Urinary Biomarkers in Cardiac Bypass Surgery: A Prospective Randomized Trial Comparing Three Surgical Techniques

Autor: S. Deininger, Wolfgang Koenig, K. Müller-Eising, H. Gorki, Andreas Liebold, Markus Hoenicka, P. Rupp
Rok vydání: 2015
Předmět:
Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Time Factors
Coronary Artery Bypass
Off-Pump
Urology
Renal function
Fatty Acid-Binding Proteins
Kidney
law.invention
chemistry.chemical_compound
Extracorporeal Membrane Oxygenation
Lipocalin-2
Risk Factors
law
Germany
medicine
Cardiopulmonary bypass
Humans
Hepatitis A Virus Cellular Receptor 1
Prospective Studies
Coronary Artery Bypass
Minimized extracorporeal circulation
Aged
Glutathione Transferase
Creatinine
Cardiopulmonary Bypass
Heparin
business.industry
Extracorporeal circulation
Acute kidney injury
Anticoagulants
Acute Kidney Injury
Middle Aged
medicine.disease
Surgery
Isoenzymes
Treatment Outcome
medicine.anatomical_structure
chemistry
Bypass surgery
Female
Cardiology and Cardiovascular Medicine
business
Biomarkers
Glomerular Filtration Rate
Zdroj: The Thoracic and Cardiovascular Surgeon. 64:561-568
ISSN: 1439-1902
0171-6425
DOI: 10.1055/s-0035-1567871
Popis: Background Cardiopulmonary bypass procedure is associated with an increased risk of renal impairment. To which extent structural damage causes functional decline is unknown. We evaluated perioperative kidney injury and function in patients treated with conventional extracorporeal circulation (CECC), minimized extracorporeal circulation (MECC), and off-pump coronary artery bypass grafting (OPCAB). Methods Blood and urine samples, collected at baseline and up to 72 hours after surgery from patients of the HEPCON trial (DRKS00007580, 120 patients randomized for heparin management and for surgical technique), were analyzed for differences in renal injury and function. Neutrophil gelatinase-associated lipocalin, α glutathione S-transferase, liver fatty acid-binding protein, and kidney injury molecule-1 were measured as urinary protein markers of renal tubular injury. Serum creatinine, blood urea levels, and estimated glomerular filtration rate were determined to monitor renal function. Results Markers of tubular injury differed significantly between surgical technique groups early after surgery, indicating the most detrimental effect in CECC. Hemolysis and hemodilution correlated with these early changes. A late rise did not show intergroup differences. Time courses of renal function parameters, as well as the development of acute kidney injury in 15 patients (13.5%), were irrespective of surgical technique. Heparin management did not influence renal parameters. Conclusion During coronary artery bypass grafting, CECC temporarily induces more tubular injury than MECC or OPCAB. However, late changes of renal function parameters occur irrespective of extracorporeal perfusion mode and even in off-pump surgery.
Databáze: OpenAIRE
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