Effect of dexamethasone on perioperative renal function impairment during cardiac surgery with cardiopulmonary bypass

Autor: Tjark Ebels, Gerjan Navis, G.W. Rietman, Robert H. Henning, BG Loef, W. van Oeveren, Anne H. Epema
Přispěvatelé: Faculteit Medische Wetenschappen/UMCG, Lifestyle Medicine (LM), Groningen Kidney Center (GKC), Vascular Ageing Programme (VAP), Cardiovascular Centre (CVC), Groningen Institute for Organ Transplantation (GIOT)
Rok vydání: 2004
Předmět:
Male
heart
cardiopulmonary bypass
renal damage
markers
law.invention
chemistry.chemical_compound
law
Prospective Studies
Coronary Artery Bypass
Kidney
complications
renal damage
steroid
Middle Aged
Cardiac surgery
steroid
dexamethasone
surgical procedures
operative
medicine.anatomical_structure
Creatinine
Anesthesia
Female
Kidney Diseases
cardiopulmonary bypass
medicine.drug
medicine.medical_specialty
Fractional excretion of sodium
complications
Renal function
dexamethasone
heart
KIDNEY
Double-Blind Method
markers
renal
INJURY
medicine
Cardiopulmonary bypass
Albuminuria
Humans
HIGH-DOSE METHYLPREDNISOLONE
Glucocorticoids
Dexamethasone
Aged
business.industry
Perioperative
EARLY TRACHEAL EXTUBATION
Surgery
CORONARY REVASCULARIZATION
Anesthesiology and Pain Medicine
chemistry
renal
business
Biomarkers
Preanesthetic Medication
Zdroj: British Journal of Anaesthesia, 93(6), 793-798. ELSEVIER SCI LTD
ISSN: 0007-0912
DOI: 10.1093/bja/aeh266
Popis: Background. In cardiac surgery with cardiopulmonary bypass (CPB), corticosteroids are administered to attenuate the physiological changes caused by the systemic inflammatory response. The effects of corticosteroids on CPB-associated renal damage have not been documented. The purpose of this study was to evaluate the effects of dexamethasone on perioperative renal dysfunction in patients undergoing cardiac surgery with CPB.Methods. Renal damage was prospectively studied in 20 patients without concomitant morbidity undergoing coronary artery surgery with CPB. Patients were randomized in a double-blind fashion to receive dexamethasone or placebo. Markers of glomerular function (creatinine clearance) and damage (microalbuminuria), and markers of tubular function (fractional excretion of sodium and free water clearance) and damage (N-acetyl-beta-d glucosaminidase (NAG)) were evaluated in addition to plasma and urinary glucose levels. Plasma and urinary specimens were obtained at the following time periods: (1) baseline, during the 12 h before surgery; (2) skin incision before heparinization; (3) from heparinization until the end of CPB; (4) during the 2 h following weaning from CPB; (5) in the intensive care unit from 2 to 6 h after weaning of CBP; (6) and from 36 to 60 h after weaning of CPB.Results. CPB was associated with an increase in markers in the placebo group, which returned to baseline during the second postoperative day, demonstrating a transient impairment of glomerular and tubular renal function. Similar patterns were observed in patients treated with dexamethasone. While postoperative glycosuria was significantly higher in the dexamethasone-treated group, no other differences between groups were observed.Conclusion. Dexamethasone administration before CPB has no protective effect on perioperative renal dysfunction in low-risk cardiac surgical patients.
Databáze: OpenAIRE
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