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For:	Kumar AB, Suneja M. Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology 2011;114:964-70. [PMID: 21394005 DOI: 10.1097/aln.0b013e318210f86a] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]

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Cited by Other Article(s)

Wu T, Li R, Chen J, Tian X, Zhang R, Hou X. Age, creatinine, and ejection fraction score is a risk factor for acute kidney injury after surgical aortic valve replacement. Ren Fail 2025;47:2444401. [PMID: 39806782 PMCID: PMC11734393 DOI: 10.1080/0886022x.2024.2444401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 12/11/2024] [Accepted: 12/13/2024] [Indexed: 01/16/2025] Open

Hilderink BN, Crane RF, Arbous SM, van den Bogaard B, Pillay J, Juffermans NP. Low postoperative mitochondrial oxygen tension is an early marker of acute kidney injury after cardiac surgery: A prospective observational study. J Crit Care 2025;88:155088. [PMID: 40267552 DOI: 10.1016/j.jcrc.2025.155088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 03/10/2025] [Accepted: 04/03/2025] [Indexed: 04/25/2025]

Ferreira PVF, Medeiros HJS, Dantas HDSR, Teixeira EV, Trevisan LP, Teixeira FDC, Soares FC, de Souza RKC, da Silva WA. Incidence and risk factors for acute kidney injury after cardiac surgery in a Brazilian University Hospital: a retrospective cross-sectional study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2025;75:844635. [PMID: 40318831 DOI: 10.1016/j.bjane.2025.844635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2025] [Revised: 04/20/2025] [Accepted: 04/22/2025] [Indexed: 05/07/2025]

Kamla CE, Meersch-Dini M, Palma LMP. Kidney Injury Following Cardiac Surgery: A Review of Our Current Understanding. Am J Cardiovasc Drugs 2025;25:337-348. [PMID: 39799538 PMCID: PMC12014718 DOI: 10.1007/s40256-024-00715-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2024] [Indexed: 01/15/2025]

He C, Norton EL, Chen EP. Redo aortic root - complexity vs simplicity with choice of device selected. Expert Rev Med Devices 2025:1-14. [PMID: 40238357 DOI: 10.1080/17434440.2025.2494641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 04/09/2025] [Accepted: 04/14/2025] [Indexed: 04/18/2025]

Grins E, Wijk J, Bjursten H, Zeaiter M, Lindstedt S, Dellgren G, Ederoth P, Lannemyr L. Acute kidney injury after lung transplantation, incidence, risk factors, and effects: A Swedish nationwide study. Acta Anaesthesiol Scand 2025;69:e70014. [PMID: 40066686 PMCID: PMC11894586 DOI: 10.1111/aas.70014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 01/26/2025] [Accepted: 02/22/2025] [Indexed: 03/14/2025]

Abstract

BACKGROUND

Acute kidney injury (AKI) is a serious complication after lung transplantation, but the reported incidence varies in the literature. No data on AKI have been published from the Swedish lung transplantation program.

METHODS

The aim of our study was to investigate the incidence, perioperative risk factors, and effects of early postoperative acute kidney injury (Kidney Disease Improving Global Outcomes [KDIGO] criteria) after lung transplantation. A retrospective, nationwide study of 568 lung-transplanted patients in Sweden between 2011 and 2020 was performed.

RESULTS

The incidence of AKI (any grade) was 42%. Renal replacement therapy was used in 5% of the patients. Preoperative factors independently associated with increased incidence of AKI were higher body mass index (odds ratio [OR]: 1.07, 95% CI: 1.02, 1.12) longer time on transplantation waiting list (OR: 1.05 [1.01, 1.09]), re-transplantation (OR: 2.24 [1.05, 4.80]) and moderate to severe tricuspid regurgitation (OR: 2.61 [1.36, 5.03]). Intraoperative factors independently associated with increased incidence of AKI were use of cardiopulmonary bypass (OR: 2.70 [1.57, 4.63]), increasing number of transfused red blood cell units, and use of immunosuppressive therapy other than routine (OR: 2,56 [1.47, 4.46]). A higher diuresis (OR: 0.70, 95% CI: 0.58-0.85) was associated with less incidence of acute kidney injury. Development of AKI was associated with increased time to extubation (median 30 h, IQR [9, 118] vs. 6 [3, 16]), length of stay in the intensive care unit (9 days [4, 25] vs. 3 [2, 5]) and increased rate of primary graft dysfunction (OR 2.33 [1.66, 3.29]) and 30-day mortality (OR: 10.8 [3.0, 69]).

CONCLUSIONS

Acute kidney injury is common after lung transplantation and affects clinical outcomes negatively. Preoperative factors may be used for risk assessment. The use of cardiopulmonary bypass is a potentially modifiable intraoperative risk factor.

EDITORIAL COMMENT

Acute kidney injury is a common complication after lung transplantation that severely influences patient outcomes. This large study of more than 500 patients treated over a decade identified potentially modifiable factors associated with the development of acute kidney injury.

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Ma S, He Q, Yang C, Zhou Z, He Y, Yu C, Yao D, Zheng L, Huang Y, Li Y. Transfusion Thresholds and Risk Factors of Acute Kidney Injury in Gastrointestinal Oncology Surgery: Insights from a Retrospective Study. Healthcare (Basel) 2025;13:525. [PMID: 40077087 PMCID: PMC11898515 DOI: 10.3390/healthcare13050525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 02/18/2025] [Accepted: 02/25/2025] [Indexed: 03/14/2025] Open

Abstract

Objectives: To identify transfusion thresholds and risk factors for acute kidney injury (AKI) in gastrointestinal oncology surgery, enhancing early intervention and improving postoperative outcomes. Methods: From 2018 to 2022, 765 patients with gastric or colorectal cancer who underwent major gastrointestinal surgery were retrospectively enrolled. The primary outcome was AKI development within 7 days postoperatively. Clinicopathological characteristics and short-term outcomes were recorded and compared. Results: Of all enrolled patients, 39 (5.1%) developed AKI. Patients with AKI were predominantly older and had more preoperative comorbidities, lower levels of preoperative hemoglobin and serum albumin, but higher levels of blood urea nitrogen and serum creatinine (SCr). Patients developing AKI experienced higher rates of in-hospital complications (overall: 48.3% vs. 14.2%, p < 0.001), prolonged hospital stays (25.4 ± 22.5 days vs. 12.3 ± 7.9 days, p < 0.001), increased intensive care unit (ICU) admissions (53.8% vs. 22.5%, p < 0.001), and higher rates of 30-day re-admission (13.9% vs. 2.4%, p = 0.003). Significant AKI risk factors included age (per 10 years, OR: 1.567, 95% CI: 1.103-2.423, p = 0.043), preoperative SCr (per 10 μmol/L, OR: 1.173, 95% CI: 1.044-1.319, p = 0.007), intraoperative RBC transfusion (per 1000 mL, OR: 1.992, 95% CI: 1.311-3.027, p = 0.001 with a significant surge in AKI risk at transfusions exceeding 1500 mL), patient-controlled analgesia (protective, OR:0.338, 95% CI: 0.163-0.928, p = 0.033), and diuretic use (OR: 5.495, 95% CI: 1.720-17.557, p = 0.004). Conclusions: Early intervention is essential for patients with preoperative low perfusion or anemia, with particular emphasis on moderating interventions to avoid fluid overload while carefully avoiding nephrotoxic medications, thereby improving postoperative outcomes.

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Affiliation(s)

Shuai Ma Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; (S.M.); (Q.H.); (C.Y.); (Z.Z.); (C.Y.); (D.Y.); (L.Z.); (Y.H.)
Qi He Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; (S.M.); (Q.H.); (C.Y.); (Z.Z.); (C.Y.); (D.Y.); (L.Z.); (Y.H.)
Chengcan Yang Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; (S.M.); (Q.H.); (C.Y.); (Z.Z.); (C.Y.); (D.Y.); (L.Z.); (Y.H.)
Zhiyuan Zhou Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; (S.M.); (Q.H.); (C.Y.); (Z.Z.); (C.Y.); (D.Y.); (L.Z.); (Y.H.)
Yining He Biostatistics Office of Clinical Research Unit, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China;
Chaoran Yu Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; (S.M.); (Q.H.); (C.Y.); (Z.Z.); (C.Y.); (D.Y.); (L.Z.); (Y.H.)
Danhua Yao Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; (S.M.); (Q.H.); (C.Y.); (Z.Z.); (C.Y.); (D.Y.); (L.Z.); (Y.H.)
Lei Zheng Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; (S.M.); (Q.H.); (C.Y.); (Z.Z.); (C.Y.); (D.Y.); (L.Z.); (Y.H.)
Yuhua Huang Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; (S.M.); (Q.H.); (C.Y.); (Z.Z.); (C.Y.); (D.Y.); (L.Z.); (Y.H.)
Yousheng Li Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; (S.M.); (Q.H.); (C.Y.); (Z.Z.); (C.Y.); (D.Y.); (L.Z.); (Y.H.)

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Miralles Bagán J, Parrilla Quiles L, Paniagua Iglesias P, Betbesé Roig AJ, Sabaté Tenas S, Pérez García S, García Álvarez M. The Potential Role of Albumin in Reducing Cardiac Surgery-Associated Acute Kidney Injury: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2025;39:453-460. [PMID: 39922683 DOI: 10.1053/j.jvca.2024.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 09/29/2024] [Accepted: 10/02/2024] [Indexed: 02/10/2025]

Abstract

OBJECTIVES

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication with high morbidity and mortality. This study was designed to determine whether adding human albumin to the cardiopulmonary bypass (CPB) priming solution reduces the incidence of CSA-AKI.

DESIGN

A double-blind, randomized controlled trial (RCT) involving 248 patients scheduled for cardiac surgery with CPB.

SETTING

A single-center tertiary university hospital.

PARTICIPANTS

Adults with a baseline estimated glomerular filtration rate (eGFR) of ≥60 mL/min/1.73 m2 and left ventricular ejection fraction ≥40%.

INTERVENTIONS

Patients were randomized to receive either a crystalloid priming solution (Plasma-Lyte) plus 4% albumin (intervention group, n = 126) or a crystalloid solution alone (control group, n = 122) for CPB.

MEASUREMENTS AND MAIN RESULTS

Data analyses were performed using the Chi-square test and Student's t-test, or their nonparametric equivalent. The primary outcome was the incidence of CSA-AKI, as defined by the Kidney Disease Improving Global Outcomes criteria, within 5 days postoperatively. Both cohorts were comparable in baseline and perioperative characteristics, including preoperative albumin levels. The incidence of CSA-AKI was 29.3% (n = 37) in the intervention group compared with 31.2% (n = 38) in the control group (odds ratio: 0.91, 95% confidence interval: 0.53-1.58). The observed difference in CSA-AKI incidence between the groups was not statistically significant. A post-hoc subgroup analysis of patients with a baseline eGFR of 60 to 70 mL/min/1.73 m² indicated a trend toward a reduced incidence of CSA-AKI in the intervention group compared with the control group (35.7% v 57.6%; odds ratio: 0.41, 95% confidence interval: 0.16-1.03). This trend was not observed in patients with an eGFR greater than 70 mL/min/1.73 m². No significant differences were observed between groups for the need for inotropes or vasoconstrictors, incidence of cardiogenic or distributive shock, bleeding, need for transfusion, or use of nephrotoxic drugs.

CONCLUSIONS

Adding albumin to the CPB priming solution did not decrease the incidence of CSA-AKI in patients with normal preoperative renal function. These findings suggest that albumin might benefit patients with impaired renal function, warranting further investigation.

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Güneş I, Dursun AD, Özdemir Ç, Küçük A, Sezen ŞC, Arslan M, Özer A. Effects of Cerium Oxide on Kidney and Liver Tissue Damage in an Experimental Myocardial Ischemia-Reperfusion Model of Distant Organ Damage. MEDICINA (KAUNAS, LITHUANIA) 2024;60:2044. [PMID: 39768923 PMCID: PMC11728079 DOI: 10.3390/medicina60122044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 11/25/2024] [Accepted: 12/06/2024] [Indexed: 01/16/2025]

Abstract

Background and Objectives: Ischemia-reperfusion (I/R) injury is a process in which impaired perfusion is restored by restoring blood flow and tissue recirculation. Nanomedicine uses cutting-edge technologies that emerge from interdisciplinary influences. In the literature, there are very few in vivo and in vitro studies on how cerium oxide (CeO2) affects systemic anti-inflammatory response and inflammation. Therefore, in our study, we aimed to investigate whether CeO2 administration has a protective effect against myocardial I/R injury in the liver and kidneys. Materials and Methods: Twenty-four rats were randomly divided into four groups after obtaining approval from an ethics committee. A control (group C), cerium oxide (group CO), IR (group IR), and Cerium oxide-IR (CO-IR group) groups were formed. Intraperitoneal CeO2 was administered at a dose of 0.5 mg/kg 30 min before left thoracotomy and left main coronary (LAD) ligation, and myocardial muscle ischemia was induced for 30 min. After LAD ligation was removed, reperfusion was performed for 120 min. All rats were euthanized using ketamine, and blood was collected. Liver and kidney tissue samples were evaluated histopathologically. Serum AST (aspartate aminotransferase), ALT (alanine aminotransaminase), GGT (gamma-glutamyl transferase), glucose, TOS (Total Oxidant Status), and TAS (Total Antioxidant Status) levels were also measured. Results: Necrotic cell and mononuclear cell infiltration in the liver parenchyma of rats in the IR group was observed to be significantly increased compared to the other groups. Hepatocyte degeneration was greater in the IR group compared to groups C and CO. Vascular vacuolization and hypertrophy, tubular degeneration, and necrosis were increased in the kidney tissue of the IR group compared to the other groups. Tubular dilatation was significantly higher in the IR group than in the C and CO groups. TOS was significantly higher in all groups than in the IR group (p < 0.0001, p < 0.0001, and p = 0.006, respectively). However, TAS level was lower in the IR group than in the other groups (p = 0.002, p = 0.020, and p = 0.031, respectively). Renal and liver histopathological findings decreased significantly in the CO-IR group compared to the IR group. A decrease in the TOS level and an increase in the TAS level were found compared to the IR group. The AST, ALT, GGT, and Glucose levels are shown. Conclusions: CeO2 administered before ischemia-reperfusion reduced oxidative stress and ameliorated IR-induced damage in distant organs. We suggest that CeO2 exerts protective effects in the myocardial IR model.

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Rahouma M, Khairallah S, Lau C, Al Zghari T, Girardi L, Mick S. The impact of comorbidities on outcomes of concomitant mitral valve intervention with ascending aortic surgery. Int J Cardiol 2024;413:132398. [PMID: 39069093 DOI: 10.1016/j.ijcard.2024.132398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/10/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024]

Abstract

INTRODUCTION

The Charlson Comorbidity Index (CCI) is widely utilized for risk stratification for non-cardiac surgical patients, yet it has not been broadly validated in patients undergoing cardiac surgery. We aim to assess its ability to predict early and late outcomes of concomitant mitral valve intervention with ascending aortic surgery.

METHODS

Patients who underwent surgery between 1997 and 2022 were reviewed. Age-adjusted CCI scores were calculated based on clinical status at a time of index operation. The primary endpoint was all causes mortality while secondary outcomes were major adverse events (MAE) that included combined perioperative mortality, dialysis, myocardial infarction, and stroke in addition to the individual outcomes and take back for bleeding and tracheostomy. Chi-square test, Logistic and Cox regression analysis, and Kaplan-Meier curves were used. Maximally selected rank statistics were used to identify best cutoff of CCI for late mortality.

RESULTS

186 patients (median age 65 [interquartile range (IQR): 54-76] and 69% males) were included with a median CCI of 4 [IQR: 3-6]. Five and ten-years overall survival were 95.9% and 67.1% vs 59.7%, and 19.9% in CCI ≤ 5 vs >5 (P < 0.001). On multivariate Cox regression analysis, higher CCI (HR 1.60 [1.17;2.18], P = 0.00), and lower EF (HR 0.89 [0.83;0.96], P = 0.002) were associated with late mortality. There was a trend to lower mortality in recent surgery years (HR 0.91 [0.83;1.01], P = 0.070)). Perioperative MAE was higher in CCI >5 (11.0% vs 2.1%, P = 0.017), and postoperative need for tracheostomy and CVA had a trend to be higher in CCI > 5 (P = 0.055). Logistic regression revealed that higher CCI, as a continuous variable, was associated with significantly higher odds of MAE, postoperative dialysis, and need for tracheostomy.

CONCLUSIONS

The CCI can be a helpful tool in predicting outcomes of patients undergoing concomitant mitral valve intervention with ascending aortic surgery.

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Bouisset B, Pozzi M, Ruste M, Varin T, Vola M, Rodriguez T, Jolivet ML, Chiari P, Fellahi JL, Jacquet-Lagreze M. Cardiopulmonary Bypass Blood Flow Rates and Major Adverse Kidney Events in Cardiac Surgery: A Propensity Score-adjusted Before-After Study. J Cardiothorac Vasc Anesth 2024;38:2213-2220. [PMID: 39095213 DOI: 10.1053/j.jvca.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/06/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024]

Affiliation(s)

Benoit Bouisset Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron Cedex, France.
Matteo Pozzi Service de Chirurgie Cardiovasculaire de l'Adulte, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron Cedex, France; Laboratoire RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon Cedex, France
Martin Ruste Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron Cedex, France; Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon Cedex, France; Laboratoire CarMeN, Inserm UMR 1060, Université Claude Bernard Lyon 1, Bron Cedex, France
Thomas Varin Service de Chirurgie Cardiovasculaire de l'Adulte, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron Cedex, France
Marco Vola Service de Chirurgie Cardiovasculaire de l'Adulte, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron Cedex, France; Laboratoire RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon Cedex, France
Thomas Rodriguez Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron Cedex, France
Maxime Le Jolivet Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron Cedex, France
Pascal Chiari Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron Cedex, France; Laboratoire CarMeN, Inserm UMR 1060, Université Claude Bernard Lyon 1, Bron Cedex, France
Jean-Luc Fellahi Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron Cedex, France; Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon Cedex, France; Laboratoire CarMeN, Inserm UMR 1060, Université Claude Bernard Lyon 1, Bron Cedex, France
Matthias Jacquet-Lagreze Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron Cedex, France; Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon Cedex, France; Laboratoire CarMeN, Inserm UMR 1060, Université Claude Bernard Lyon 1, Bron Cedex, France

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Goto S, Hosojima M, Kabasawa H, Arai K, Takemoto K, Aoki H, Komochi K, Kobayashi R, Sugita N, Endo T, Kaseda R, Yoshida Y, Narita I, Hirayama Y, Saito A. Megalin-related mechanism of hemolysis-induced acute kidney injury and the therapeutic strategy. J Pathol 2024;263:315-327. [PMID: 38721910 DOI: 10.1002/path.6284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/08/2024] [Accepted: 03/15/2024] [Indexed: 06/12/2024]

Abstract

Hemolysis-induced acute kidney injury (AKI) is attributed to heme-mediated proximal tubule epithelial cell (PTEC) injury and tubular cast formation due to intratubular protein condensation. Megalin is a multiligand endocytic receptor for proteins, peptides, and drugs in PTECs and mediates the uptake of free hemoglobin and the heme-scavenging protein α1-microglobulin. However, understanding of how megalin is involved in the development of hemolysis-induced AKI remains elusive. Here, we investigated the megalin-related pathogenesis of hemolysis-induced AKI and a therapeutic strategy using cilastatin, a megalin blocker. A phenylhydrazine-induced hemolysis model developed in kidney-specific mosaic megalin knockout (MegKO) mice confirmed megalin-dependent PTEC injury revealed by the co-expression of kidney injury molecule-1 (KIM-1). In the hemolysis model in kidney-specific conditional MegKO mice, the uptake of hemoglobin and α1-microglobulin as well as KIM-1 expression in PTECs was suppressed, but tubular cast formation was augmented, likely due to the nonselective inhibition of protein reabsorption in PTECs. Quartz crystal microbalance analysis revealed that cilastatin suppressed the binding of megalin with hemoglobin and α1-microglobulin. Cilastatin also inhibited the specific uptake of fluorescent hemoglobin by megalin-expressing rat yolk sac tumor-derived L2 cells. In a mouse model of hemolysis-induced AKI, repeated cilastatin administration suppressed PTEC injury by inhibiting the uptake of hemoglobin and α1-microglobulin and also prevented cast formation. Hemopexin, another heme-scavenging protein, was also found to be a novel ligand of megalin, and its binding to megalin and uptake by PTECs in the hemolysis model were suppressed by cilastatin. Mass spectrometry-based semiquantitative analysis of urinary proteins in cilastatin-treated C57BL/6J mice indicated that cilastatin suppressed the reabsorption of a limited number of megalin ligands in PTECs, including α1-microglobulin and hemopexin. Collectively, cilastatin-mediated selective megalin blockade is an effective therapeutic strategy to prevent both heme-mediated PTEC injury and cast formation in hemolysis-induced AKI. © 2024 The Pathological Society of Great Britain and Ireland.

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Affiliation(s)

Sawako Goto Department of Applied Molecular Medicine, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Michihiro Hosojima Department of Clinical Nutrition Science, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Hideyuki Kabasawa Department of Clinical Nutrition Science, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Kaho Arai Department of Applied Molecular Medicine, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Kazuya Takemoto Department of Applied Molecular Medicine, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Hiroyuki Aoki Department of Clinical Nutrition Science, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Koichi Komochi Department of Clinical Nutrition Science, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Ryota Kobayashi Department of Clinical Nutrition Science, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Nanako Sugita Department of Clinical Nutrition Science, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Taeko Endo Department of Applied Molecular Medicine, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Ryohei Kaseda Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Yutaka Yoshida Department of Bacteriology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Ichiei Narita Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Yoshiaki Hirayama Vaccine & Diagnostic R&D Department, Denka Co., Ltd., Gosen, Japan
Akihiko Saito Department of Applied Molecular Medicine, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

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Floh AA, Ginter DC. Breaking Under Pressure: Cardiorenal Syndrome and Elevated Central Venous Pressures in Children With Heart Disease. JACC. ADVANCES 2024;3:100992. [PMID: 39130047 PMCID: PMC11312793 DOI: 10.1016/j.jacadv.2024.100992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]

Wilnes B, Castello-Branco B, Branco BC, Sanglard A, Vaz de Castro PAS, Simões-e-Silva AC. Urinary L-FABP as an Early Biomarker for Pediatric Acute Kidney Injury Following Cardiac Surgery with Cardiopulmonary Bypass: A Systematic Review and Meta-Analysis. Int J Mol Sci 2024;25:4912. [PMID: 38732152 PMCID: PMC11084509 DOI: 10.3390/ijms25094912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open

Milne B, Gilbey T, De Somer F, Kunst G. Adverse renal effects associated with cardiopulmonary bypass. Perfusion 2024;39:452-468. [PMID: 36794518 PMCID: PMC10943608 DOI: 10.1177/02676591231157055] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]

Şengel N, Küçük A, Özdemir Ç, Sezen ŞC, Kip G, Er F, Dursun AD, Polat Y, Kavutçu M, Arslan M. The Effect of Sevoflurane and Fullerenol C 60 on the Liver and Kidney in Lower Extremity Ischemia-Reperfusion Injury in Mice with Streptozocin-Induced Diabetes. Int J Nanomedicine 2023;18:7543-7557. [PMID: 38111848 PMCID: PMC10725837 DOI: 10.2147/ijn.s432924] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/30/2023] [Indexed: 12/20/2023] Open

Abstract

Objective

This study aimed to demonstrate whether fullerenol C60, sevoflurane anesthesia, or a combination of both had protective effects on the liver and kidneys in lower extremity ischemia-reperfusion injury (IRI) in mice with streptozocin-induced diabetes.

Methods

A total of 46 Swiss albino mice were divided into six groups as follows: control group (group C, n=7), diabetes group (group D, n=7), diabetes-ischemia/reperfusion (group DIR, n=8), diabetes-ischemia/reperfusion-fullerenol C60 (group DIR-FC60, n=8), diabetes-ischemia/reperfusion-sevoflurane (group DIR-S, n=8), and the diabetes-ischemia/reperfusion-fullerenol C60-sevoflurane (group DIR-S-FC60, n=8). Fullerenol C60 (100mg/kg) was administered intraperitoneally 30 min before the ischemia-reperfusion procedure to the fullerenol groups (DIR-FC60 and DIR-S-FC60). In the DIR groups, 2 hours (h) ischemia-2h reperfusion periods were performed. In the sevoflurane groups, sevoflurane was applied during the ischemia-reperfusion period with 100% O2. Liver and kidney tissues were removed at the end of the reperfusion procedure for biochemical and histopathological examinations.

Results

In liver tissue, hydropic degeneration, sinusoidal dilatation, pycnotic nuclei, prenecrotic cells, and mononuclear cell infiltration in parenchyma were significantly more frequent in group DIR than in groups D and group C. In terms of the histopathologic criteria examined, more positive results were seen in group DIR-FC60, and when group DIR-FC60 was compared with group DIR, the difference was significant. The best results in AST, ALT, glucose, TBARS levels, and SOD enzyme activities in liver tissue were in group DIR-FC60 compared with group DIR, followed by groups DIR-S-FC60 and DIR-S, respectively. Regarding TBARS levels and SOD enzyme activities in kidney tissue, the best results were in groups DIR-FC60, DIR-S-FC60, and DIR-S, respectively.

Conclusion

According to our findings, it is clear that fullerenol C60 administered intraperitoneally 30 min before ischemia, alone or together with sevoflurane, reduces oxidative stress in distant organ damage caused by lower extremity IRI, and reduces liver and kidney tissue damage in histopathologic examinations.

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Xing J, Loh SKN. Perioperative acute kidney injury: Current knowledge and the role of anaesthesiologists. PROCEEDINGS OF SINGAPORE HEALTHCARE 2023. [DOI: 10.1177/20101058231163406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open

Zhang X, Miao Q, Yu C, Zhang Y, Wu D, Tian Y, Li H, Wang C. Postoperative acute kidney injury after on-pump cardiac surgery in patients with connective tissue disease. Front Cardiovasc Med 2023;10:1266549. [PMID: 38028488 PMCID: PMC10646509 DOI: 10.3389/fcvm.2023.1266549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open

Gu W, Qing H, Luo X, Zang X, Zhou K, Guo H, Zhou C, Guo H, Liu J. Del-Nido cardioplegia in cardiac surgery for elderly patients: a propensity score-matched analysis. J Cardiothorac Surg 2023;18:161. [PMID: 37098556 PMCID: PMC10131453 DOI: 10.1186/s13019-023-02269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/04/2023] [Indexed: 04/27/2023] Open

Abstract

OBJECTIVES

To compare the safety and efficacy of del-Nido cardioplegia (DNC) with traditional 4:1 cold blood cardioplegia (CBC) in coronary artery bypass grafting and/or valve surgeries in elderly patients.

METHODS

The present study is a retrospective case-series study that included 302 consecutive patients aged 70 years and over who underwent on-pump valve surgery and/or coronary artery bypass graft (CABG). DNC was administered to 90 patients and CBC to 212 patients. After propensity-score matching, 89 pairs were compared. The safety and efficacy were analyzed between the two groups.

RESULTS

The DNC group had a similar mortality (3.4% vs. 5.6%, OR = 0.79, P = 0.720) and extracorporeal membrane oxygenation (ECMO) implantation rate (1.1% vs. 2.2%, OR = 0.75, P = 1.000) to the CBC group, a lower incidence of postoperative intra-aortic balloon pump (IABP) implantation (1.1% vs. 9.0%, OR = 0.54, P = 0.034) and a higher left ventricular ejection fraction (LVEF) at discharge (60 (56-64) % vs. 57 (51-62)%, P = 0.007). The estimated glomerular filtration rate (eGFR) in the DNC group was higher when the patient was transferred to the intensive care unit (79.4 (65.0-94.3) ml/min/1.73m² vs. 77.2 (59.8-88.7) ml/min/1.73m², P = 0.014), but no significant differences were identified after 24 h. The serum lactate values of the DNC group were significantly lower than those of the CBC group (0 h: 2.7 (2.0-3.2) vs. 3.2 (2.4-4.4), P = 0.001; 3 h: 3.2 (2.0-4.8) vs. 4.8 (2.8-6.6), P < 0.001; 6 h: 3.5 (2.2-5.4) vs. 5.8 (3.4-8.4), P < 0.001; 9 h: 3.4 (2.0-7.0) vs. 5.5 (2.9-8.3), P = 0.005). There were no differences between the two groups in respect of lactate levels at 12 h and thereafter. Postoperative creatinine kinase-MB concentrations were similar between the two groups.

CONCLUSIONS

Del-Nido cardioplegia is safe and effective in elderly patients undergoing CABG and/or valve surgery.

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Affiliation(s)

Wenda Gu Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
Hongkun Qing Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
Xiang Luo Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
Xin Zang Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
Kan Zhou Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
Haijiang Guo Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
Chengbin Zhou Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
Huiming Guo Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China
Jian Liu Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, 510080, China.

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Nguyen M, Stiel L, Guilloteau A, Bahr PA, Masson D, Thomas C, Blot M, Guy J, Fontaine C, Durand B, Bouhemad B, Guinot PG. Leukocyte cell population data in patients with cardiac surgery and cardiopulmonary bypass: A potential readily available tool to monitor immunity. Front Immunol 2023;13:1101937. [PMID: 36741408 PMCID: PMC9892932 DOI: 10.3389/fimmu.2022.1101937] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/30/2022] [Indexed: 01/21/2023] Open

Abstract

Purpose

Cardiac surgery with cardiopulmonary bypass triggers sterile inflammation that is responsible for post-operative morbidity. Automated flow cytometry devices used for leucocyte count provide cell population data (CPD) regarding fluorescence intensity, size and granularity of leukocytes that have never been studied in the context of sterile inflammation. Our objective was to explore leukocyte cell population data in patients undergoing cardiac surgery with cardiopulmonary bypass in order to determine whether CPD could be used to monitor immune cell activation.

Methods

This is an ancillary study of a cohort of patients undergoing cardiac surgery with cardiopulmonary bypass. Cell population data (CPD) extracted from a routine automated flow cytometer were analyzed (Fluorescence targeted to nucleic acids). The time points of interest were: pre-operative, postoperative and 5 days after surgery. The variations in those parameters were studied. Data were then compared between patients according to the occurrence of a composite criteria (supra-ventricular arrythmia, stroke, acute renal failure, and/or death).

Results

Data from 1453 patients were analyzed. The neutrophil count, fluorescence granularity (NE-SCC), intensity (NE-SFL) and size (NE-FSC) increased with surgery. Heterogeneity of neutrophils decreased in terms of fluorescence granularity (NE-WX) and size (NE-WZ) but increased in terms of intensity (NE-WY). The lymphocyte count decreased with surgery. While fluorescence granularity (LY-X) and size increased (LY-Z), Lymphocyte intensity decreased (LY-Y). Lymphocytes were less heterogeneous in terms of their granularity, size and intensity after surgery (LY-WX, LY-WY, LY-WZ). Patients who developed the composite complication criteria had a higher pre-operative neutrophil count (5.08 [3.89;6.95] vs 4.76 [3.60;6.13], p = 0.02; AUC = 0.56 [0.51;0.60]), and more heterogeneous neutrophils in terms of fluorescence granularity (NE-WX, AUC = 0.57 [0.52;0.62]) and intensity (NE-WY, AUC 0.61 [0.56;0.65]). Those patients also had lower pre-operative lymphocyte count (1.49 [1.10;1.14] vs 1.81 [1.39;2.39], p<0.01, AUC = 0.61 [0.57;0.66]) and fluorescence granularity (LY-X, AUC = 0.57 [0.53;0.62]). NE-WX, NE-WY and LY-X were associated with post-operative complications after adjustment on the EuroSCORE 2 (adjusted odd ratio of 1.01 [1.00;1.02]; 1.01 [1.00;1.01] and 1.08 [1.02;1.15] respectively).

Conclusion

Cardiac surgery with cardiopulmonary bypass was associated with substantial alterations of CPD probably reflecting leukocytes activation in sterile inflammation. Pre-operative NE-WX, NE-WY and LY-X biomarkers levels were associated with post-operative complications, independently of the EuroSCORE 2. Such routine, unexploited and low cost parameters might represent useful tools likely to monitor immune function and predict outcomes for patients undergoing cardiac surgery. Our findings requires validation on a larger external cohort.

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Affiliation(s)

Maxime Nguyen Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France,University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France,INSERM, LNC UMR1231, Dijon, France,LipSTIC LabEx, Dijon, France,*Correspondence: Maxime Nguyen,
Laure Stiel INSERM, LNC UMR1231, Dijon, France,LipSTIC LabEx, Dijon, France,Service de Réanimation Médicale, Groupe Hospitalier de la Région Mulhouse Sud Alsace, Mulhouse, France
Adrien Guilloteau Clinical Research Support Unit, Dijon University Hospital, Dijon, France
Pierre-Alain Bahr Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France
David Masson University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France,INSERM, LNC UMR1231, Dijon, France,LipSTIC LabEx, Dijon, France
Charles Thomas University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France,INSERM, LNC UMR1231, Dijon, France,LipSTIC LabEx, Dijon, France
Mathieu Blot University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France,INSERM, LNC UMR1231, Dijon, France,LipSTIC LabEx, Dijon, France,Department of Infectiology, Dijon University Hospital, Dijon, France
Julien Guy Cytometry Core Facility, University of Burgundy Franche-Comté, Dijon, France
Cécile Fontaine Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France
Bastien Durand Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France
Belaid Bouhemad Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France,University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France,INSERM, LNC UMR1231, Dijon, France,LipSTIC LabEx, Dijon, France
Pierre-Grégoire Guinot Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France,University of Burgundy and Franche-Comté, LNC UMR1231, Dijon, France,INSERM, LNC UMR1231, Dijon, France,LipSTIC LabEx, Dijon, France

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Salmasi MY, Ravishankar R, Abdullahi Y, Hartley P, Kyriazis PG, Athanasiou T, Punjabi P. Predictors of outcome after CABG in the South-Asian community: a propensity matched analysis. Perfusion 2023;38:75-84. [PMID: 34365853 PMCID: PMC9841816 DOI: 10.1177/02676591211037577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]

Abstract

BACKGROUND

Ethnicity is not incorporated into standardized pre-operative risk-stratification tools for cardiac surgery. This study compared short-term outcomes following coronary artery bypass graft (CABG) surgery in South Asian and non-Asian patients.

METHODS

Consecutive patients undergoing isolated CABG surgery via sternotomy between the years 2011 and 2019 were retrospectively analyzed. Initially, 1957 patients were identified (799 South-Asian, 40.8%). The patient groups were then propensity matched according to 10 relevant pre-operative covariates (age, body mass index, pulmonary disease, renal failure, smoking, diabetes, ventricular function, renal failure): 675 non-Asian patients were matched against 675 Asian patients.

RESULTS

Operative mortality was 1.77% and similar between the two groups (p = 0.447). Multivariate regression analysis found predictors of operative mortality to be pre-operative serum creatinine, age, left ventricular (LV) impairment, and extent of coronary disease. The effect of creatinine on mortality was selective for South-Asian patients (p = 0.015). LV impairment was a predictor of mortality in non-Asian patients, however this effect did not exist in South-Asian patients. Predictors of short-term complications (composite of death, stroke, reoperation, hemofiltration, and pneumonia) were age and creatinine (coefficient 0.002, 95% CI 0.0004-0.004, p = 0.019) in the overall cohort. Subgroup analysis found age to remain a selective negative predictor of complications in South-Asian patients. Cox regression analysis found creatinine, age, and LVEF to influence 10-year survival, whilst ethnicity was not a predictor.

CONCLUSION

This study highlights the cumulative risk associated with ethnicity and renal disease in predicting short-term outcomes following CABG. This warrants further investigations in larger populations, thus guiding pre-operative risk-stratification.

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Uduagbamen P, Sanusi M, Udom O. Original research gender differences in recovering from cardiac and vascular surgery associated acute kidney injury: A six-year retrospective comparative study in Nigeria. Ann Afr Med 2023;22:160-166. [PMID: 37026196 DOI: 10.4103/aam.aam_81_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open

Milne B, Gilbey T, Kunst G. Perioperative Management of the Patient at High-Risk for Cardiac Surgery-Associated Acute Kidney Injury. J Cardiothorac Vasc Anesth 2022;36:4460-4482. [PMID: 36241503 DOI: 10.1053/j.jvca.2022.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/27/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022]

Thomas K, Zondler L, Ludwig N, Kardell M, Lüneburg C, Henke K, Mersmann S, Margraf A, Spieker T, Tekath T, Velic A, Holtmeier R, Hermann J, Jankowski V, Meersch M, Vestweber D, Westphal M, Roth J, Schäfers MA, Kellum JA, Lowell CA, Rossaint J, Zarbock A. Glutamine prevents acute kidney injury by modulating oxidative stress and apoptosis in tubular epithelial cells. JCI Insight 2022;7:163161. [PMID: 36107633 PMCID: PMC9675453 DOI: 10.1172/jci.insight.163161] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/12/2022] [Indexed: 12/15/2022] Open

Affiliation(s)

Katharina Thomas Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
Lisa Zondler Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
Nadine Ludwig Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
Marina Kardell Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
Corinna Lüneburg Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
Katharina Henke Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
Sina Mersmann Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
Andreas Margraf Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
Tilmann Spieker Institute for Pathology, St. Franziskus Hospital Münster, Münster, Germany
Tobias Tekath Institute of Medical Informatics, University of Münster, Münster, Germany
Ana Velic Department of Quantitative Proteomics, University of Tübingen, Tübingen, Germany
Richard Holtmeier Institute of Clinical Radiology, University Hospital Münster, Münster, Germany
Juliane Hermann Institute for Molecular Cardiovascular Research, RWTH Aachen University Hospital, Aachen, Germany
Vera Jankowski Institute for Molecular Cardiovascular Research, RWTH Aachen University Hospital, Aachen, Germany
Melanie Meersch Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
Dietmar Vestweber Max Planck Institute for Molecular Biomedicine, Münster, Germany
Martin Westphal Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.,Fresenius Kabi AG, Bad Homburg, Germany
Johannes Roth Institute for Immunology, University of Münster, Münster
Michael A. Schäfers European Institute for Molecular Imaging, University Hospital Münster, Münster, Germany
John A. Kellum Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Clifford A. Lowell Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
Jan Rossaint Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
Alexander Zarbock Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany

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Palomba H, Treml RE, Caldonazo T, Katayama HT, Gomes BC, Malbouisson LMS, Silva Junior JM. Intraoperative fluid balance and cardiac surgery-associated acute kidney injury: a multicenter prospective study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2022;72:688-694. [PMID: 35917847 PMCID: PMC9659999 DOI: 10.1016/j.bjane.2022.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 05/16/2023]

Şengel N, Köksal Z, Dursun AD, Kurtipek Ö, Sezen ŞC, Arslan M, Kavutçu M. Effects of Dexmedetomidine Administered Through Different Routes on Kidney Tissue in Rats with Spinal Cord Ischaemia-Reperfusion Injury. Drug Des Devel Ther 2022;16:2229-2239. [PMID: 35860522 PMCID: PMC9289575 DOI: 10.2147/dddt.s361618] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open

Abstract

BACKGROUND

Ischaemia-reperfusion (IR) injury, which can be encountered during surgical procedures involving the abdominal aorta, is a complex process that affects distant organs, such as the heart, liver, kidney, and lungs, as well as the lower extremities. In this study, we aimed to contribute to the limited literature by investigating the protective effect of dexmedetomidine, which was administered through different routes, on kidney tissue in rats with spinal cord IR injury.

METHODS

A total of 30 rats were randomly divided into five groups: control (C group), IR (IR group), IR-intraperitoneal dexmedetomidine (IRIPD group), IR-intrathecal dexmedetomidine (IRITD group), and IR-intravenous dexmedetomidine (IRIVD group). The spinal cord IR model was established. Dexmedetomidine was administered at doses of 100 µg/kg intraperitoneally, 3 µg/kg intrathecally, and 9 µg/kg intravenously. Histopathologic parameters in kidney tissue samples taken at the end of the reperfusion period and biochemical parameters in serum were evaluated.

RESULTS

When examined histopathologically, tubular dilatation was found to be significantly reduced in the IRIVD, IRITD, and IRIPD groups compared with the IR group (p = 0.012, all). Vascular vacuolization and hypertrophy were significantly decreased in the IRIVD, IRITD, and IRIPD groups compared with the IR group (p = 0.006, all). Tubular cell degeneration and necrosis were significantly reduced in the IRIVD, IRITD, and IRIPD groups compared with the IR group (p = 0.008, p = 0.08, and p = 0.030, respectively). Lymphocyte infiltration was significantly decreased in the IRIVD and IRITD groups compared with the IR group (p = 0.006 and p = 0.06, respectively).

CONCLUSION

It was observed that dexmedetomidine administered by different routes improved the damage caused by IR in kidney histopathology. We think that the renoprotective effects of dexmedetomidine administered intravenously and intrathecally before IR in rats are greater.

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Karamchandani K, McDowell BJ, Raghunathan K, Krishnamoorthy V, Lehman EB, Ohnuma T, Bonavia A. Failure to Rescue After Severe Acute Kidney Injury in Patients Undergoing Non-Cardiac Surgery. J Surg Res 2022;279:148-163. [PMID: 35777347 DOI: 10.1016/j.jss.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/28/2022] [Accepted: 05/21/2022] [Indexed: 11/30/2022]

Koponen T, Musialowicz T, Lahtinen P. Gelatin and the risk of acute kidney injury after cardiac surgery. Acta Anaesthesiol Scand 2022;66:215-222. [PMID: 34811729 DOI: 10.1111/aas.14004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 12/11/2022]

Kolsrud O, Barbu M, Dellgren G, Björk K, Corderfeldt A, Thoren A, Jeppsson A, Ricksten S. Dextran-based priming solution during cardiopulmonary bypass attenuates renal tubular injury-A secondary analysis of randomized controlled trial in adult cardiac surgery patients. Acta Anaesthesiol Scand 2022;66:40-47. [PMID: 34424995 DOI: 10.1111/aas.13975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]

Sickeler RA, Kertai MD. Risk Assessment and Perioperative Renal Dysfunction. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00008-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open

Liang W, Yu CJ, Wang QY, Yu J. Anemia is associated with increased risk of contrast‑induced acute kidney injury: A Systematic Review and Meta-analysis. Bioengineered 2021;12:648-661. [PMID: 33595423 PMCID: PMC8806332 DOI: 10.1080/21655979.2021.1883887] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/27/2021] [Indexed: 11/23/2022] Open

Gambaro A, Lombardi G, Onorati F, Gottin L, Ribichini FL. Heart, kidney and left ventricular assist device: a complex trio. Eur J Clin Invest 2021;51:e13662. [PMID: 34347897 DOI: 10.1111/eci.13662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/24/2021] [Accepted: 08/03/2021] [Indexed: 12/20/2022]

Cheng T, Barve R, Cheng YWM, Ravendren A, Ahmed A, Toh S, Goulden CJ, Harky A. Conventional versus miniaturized cardiopulmonary bypass: A systematic review and meta-analysis. JTCVS OPEN 2021;8:418-441. [PMID: 36004169 PMCID: PMC9390465 DOI: 10.1016/j.xjon.2021.09.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/24/2021] [Indexed: 11/05/2022]

Abstract

Objective

A meta-analysis of randomized controlled trials was performed to compare the effects of miniaturized extracorporeal circulation (MECC) and conventional extracorporeal circulation (CECC) on morbidity and mortality rates after cardiac surgery.

Methods

A comprehensive literature search was conducted using Ovid, PubMed, Medline, EMBASE, and the Cochrane databases. Randomized controlled trials from the year 2000 with n > 40 patients were considered. Key search terms included variations of "mini," "cardiopulmonary," "bypass," "extracorporeal," "perfusion," and "circuit." Studies were assessed for bias using the Cochrane Risk of Bias tool. The primary outcomes were postoperative mortality and stroke. Secondary outcomes included arrhythmia, myocardial infarction, renal failure, blood loss, and a composite outcome comprised of mortality, stroke, myocardial infarction and renal failure. Duration of intensive care unit, and hospital stay was also recorded.

Results

The 42 studies eligible for this study included a total of 2154 patients who underwent CECC and 2196 patients who underwent MECC. There were no significant differences in any preoperative or demographic characteristics. Compared with CECC, MECC did not reduce the incidence of mortality, stroke, myocardial infarction, and renal failure but did significantly decrease the composite of these outcomes (odds ratio, 0.64; 95% confidence interval [CI], 0.50-0.81; P = .0002). MECC was also associated with reductions in arrhythmia (odds ratio, 0.67; 95% CI, 0.54-0.83; P = .0003), blood loss (mean difference [MD], -96.37 mL; 95% CI, -152.70 to -40.05 mL; P = .0008), hospital stay (MD, -0.70 days; 95% CI, -1.21 to -0.20 days; P = .006), and intensive care unit stay (MD, -2.27 hours; 95% CI, -3.03 to -1.50 hours; P < .001).

Conclusions

MECC demonstrates clinical benefits compared with CECC. Further studies are required to perform a cost-utility analysis and to assess the long-term outcomes of MECC. These should use standardized definitions of endpoints such as mortality and renal failure to reduce inconsistency in outcome reporting.

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Grins E, Ederoth P, Bjursten H, Dardashti A, Brondén B, Metzsch C, Erdling A, Nozohoor S, Mokhtari A, Hansson MJ, Elmér E, Algotsson L, Shrestha NM, Jovinge S. Effect of Cyclosporine on Cytokine Production in Elective Coronary Artery Bypass Grafting: A Sub-Analysis of the CiPRICS (Cyclosporine to Protect Renal Function in Cardiac Surgery) Study. J Cardiothorac Vasc Anesth 2021;36:1985-1994. [PMID: 34969566 DOI: 10.1053/j.jvca.2021.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/11/2022]

Affiliation(s)

Edgars Grins Department of Cardiothoracic Anesthesia and Intensive Care, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
Per Ederoth Department of Cardiothoracic Anesthesia and Intensive Care, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
Henrik Bjursten Department of Cardiothoracic Surgery, Department of Clinical Sciences Lund University, Skåne University Hospital, Lund, Sweden
Alain Dardashti Department of Cardiothoracic Anesthesia and Intensive Care, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
Björn Brondén Department of Cardiothoracic Anesthesia and Intensive Care, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
Carsten Metzsch Department of Cardiothoracic Anesthesia and Intensive Care, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
André Erdling Department of Cardiothoracic Anesthesia and Intensive Care, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
Shahab Nozohoor Department of Cardiothoracic Surgery, Department of Clinical Sciences Lund University, Skåne University Hospital, Lund, Sweden
Arash Mokhtari Department of Cardiothoracic Surgery, Department of Clinical Sciences Lund University, Skåne University Hospital, Lund, Sweden
Magnus J Hansson Mitochondrial Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
Eskil Elmér Mitochondrial Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
Lars Algotsson Department of Cardiothoracic Anesthesia and Intensive Care, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
Nabin Manandhar Shrestha DeVos Cardiovascular Research Program, Fredrik Meijer Heart and Vascular Institute Spectrum Health/Van Andel Institute, Grand Rapids, MI
Stefan Jovinge DeVos Cardiovascular Research Program, Fredrik Meijer Heart and Vascular Institute Spectrum Health/Van Andel Institute, Grand Rapids, MI; Cardiovascular Institute, Stanford University, Palo Alto, CA

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Ellermann SF, L Scheeren TW, Jongman RM, Nordhoff K, Schnabel CL, Molema G, Theilmeier G, Meurs MV. Plasma from patients undergoing coronary artery bypass graft surgery does not activate endothelial cells under shear stress in vitro. Int J Crit Illn Inj Sci 2021;11:142-150. [PMID: 34760660 PMCID: PMC8547679 DOI: 10.4103/ijciis.ijciis_197_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 11/11/2022] Open

Yokoyama S, Imamura T, Yamashita S, Doi T, Fukahara K, Yoshimura N, Kinugawa K. Peak Lag Between Plasma Vasopressin and Urine Aquaporin-2 Following Cardiac Surgery. Int Heart J 2021;62:1057-1061. [PMID: 34544990 DOI: 10.1536/ihj.21-301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]

The relationship between renal oxygen saturation and renal function in patients with and without diabetes following coronary artery bypass grafting surgery. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.824685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open

Brain and Muscle Oxygen Saturation Combined with Kidney Injury Biomarkers Predict Cardiac Surgery Related Acute Kidney Injury. Diagnostics (Basel) 2021;11:diagnostics11091591. [PMID: 34573933 PMCID: PMC8466978 DOI: 10.3390/diagnostics11091591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 02/04/2023] Open

Rasmussen SR, Nielsen RV, Møgelvang R, Ostrowski SR, Ravn HB. Prognostic value of suPAR and hsCRP on acute kidney injury after cardiac surgery. BMC Nephrol 2021;22:120. [PMID: 33827466 PMCID: PMC8025450 DOI: 10.1186/s12882-021-02322-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/24/2021] [Indexed: 11/16/2022] Open

Abstract

Background

Acute kidney injury (AKI) represents a serious complication following cardiac surgery. Adverse outcome after cardiac surgery has been observed in the presence of elevated levels of soluble urokinase-type plasminogen activator receptor (suPAR) and high-sensitivity C-Reactive Protein (hsCRP). The aim of study was (i) to investigate the relationship between preoperative elevated levels of suPAR and hsCRP and postoperative AKI in unselected cardiac surgery patients and (ii) to assess whether the concentration of the biomarkers reflected severity of AKI.

Methods

In a retrospective observational study, biobank blood plasma samples (n = 924) from patients admitted for elective on-pump cardiac surgery were analysed for suPAR and hsCRP levels. The relation between suPAR and hsCRP-values and AKI (any stage), defined by the KDIGO (Kidney Disease: Improving Global Outcomes) criteria, was assessed using adjusted logistic regression. Further, the association between biomarkers and severity (KDIGO 1, KDIGO 2–3 and renal replacement therapy (RRT)) was assessed using adjusted logistic regression.

Results

Postoperative AKI (any stage) was observed in 327 patients (35.4 %). A doubling of preoperative suPAR corresponded to an adjusted odds ratio (OR) for postoperative AKI (any stage) of 1.62 (95 % CI 1.26–2.09, p < 0.001). Furthermore, a doubling of suPAR had an adjusted OR of 1.50 (95 % CI 1.16–1.93, p = 0.002), 2.44 (95 % CI 1.56–3.82, p < 0.001) and 1.92 (95 % CI 1.15–3.23, p = 0.002), for KDIGO 1, KDIGO 2–3 and need for RRT, respectively. No significant association was found between elevated levels of hsCRP and any degree of AKI.

Conclusions

Increasing levels of suPAR, but not hsCRP, were associated with development and severity of AKI following on-pump cardiac surgery.

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Khoshbin E, Spencer S, Solomon L, Tang A, Clark S, Stokes E, Wordsworth S, Dabner L, Edwards J, Reeves B, Rogers C. Is there a renoprotective value to leukodepletion during heart valve surgery? A randomized controlled trial (ROLO). J Cardiothorac Surg 2021;16:58. [PMID: 33771192 PMCID: PMC8004389 DOI: 10.1186/s13019-021-01402-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open

Abstract

Background

Acute Kidney Injury (AKI) adversely affects outcomes after cardiac surgery. A major mediator of AKI is the activation of leukocytes through exposure to the cardiopulmonary bypass circuit. We evaluate the use of leukodepletion filters throughout bypass to protect against post-operative AKI by removing activated leukocytes during cardiac surgery.

Methods

This is a single-centre, double-blind, randomized controlled trial comparing the use of leukodepletion versus a standard arterial filter throughout bypass. Elective adult patients undergoing heart valve surgery with or without concomitant procedures were investigated. The primary clinical outcome measured was the development of AKI according to the KDIGO criteria. Secondary measures included biomarkers of renal tubular damage (urinary Retinol Binding Protein and Kidney Injury Molecule-1), glomerular kidney injury (urinary Micro Albumin and serum Cystatin C) and urinary Neutrophil Gelatinase Associated Lipocalin, as well as the length of hospital stay and quality of life measures through EQ-5D-5L questionnaires.

Results

The ROLO trial randomized 64 participants with a rate of recruitment higher than anticipated (57% achieved, 40% anticipated). The incidence of AKI was greater in the leukodepletion filter group (44% versus 23%, risk difference 21, 95% CI − 2 to 44%). This clinical finding was supported by biomarker levels especially by a tendency toward glomerular insult at 48 h, demonstrated by a raised serum Cystatin C (mean difference 0.11, 95% CI 0.00 to 0.23, p = 0.068) in the leukodepleted group. There was however no clear association between the incidence or severity of AKI and length of hospital stay. On average, health related quality of life returned to pre-operative levels in both groups within 3 months of surgery.

Conclusions

Leukocyte depletion during cardiopulmonary bypass does not significantly reduce the incidence of AKI after valvular heart surgery. Other methods to ameliorate renal dysfunction after cardiac surgery need to be investigated.

Trial registration

The trial was registered by the International Standard Randomized Controlled Trial Number Registry ISRCTN42121335. Registered on the 18 February 2014. The trial was run by the Bristol Clinical Trials and Evaluation Unit. This trial was financially supported by the National Institute of Health Research (Research for Patient Benefit), award ID: PB-PG-0711-25,090.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13019-021-01402-4.

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Mou Z, Guan T, Chen L. Risk Factors of Acute Kidney Injury in ECMO Patients: A Systematic Review and Meta-Analysis. J Intensive Care Med 2021;37:267-277. [PMID: 33761767 DOI: 10.1177/08850666211003485] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]

Balkan B, Magin H. What are the factors affecting the progression of kidney failure, mortality and morbidity after cardiac surgery in patients with chronic kidney disease? J Card Surg 2021;36:2021-2028. [PMID: 33694184 DOI: 10.1111/jocs.15493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 01/11/2021] [Accepted: 02/28/2021] [Indexed: 10/22/2022]

Acute Kidney Injury following Cardiopulmonary Bypass: A Challenging Picture. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021;2021:8873581. [PMID: 33763177 PMCID: PMC7963912 DOI: 10.1155/2021/8873581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/02/2021] [Accepted: 02/18/2021] [Indexed: 01/10/2023]

Abbas K, Rehatta N, Sembiring Y, Adisurya G, Airlangga P, Hamzah H, Hardiono H, Semedi B, Waluejo C. Acute kidney injury after a coronary artery bypass graft surgery. BALI JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.4103/bjoa.bjoa_249_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open

Sleep Quality after Coronary Artery Bypass Graft Surgery: Comparing Pulsatile and Nonpulsatile Pump Flow. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2020;52:314-318. [PMID: 33343034 DOI: 10.1182/ject-2000024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/03/2020] [Indexed: 12/27/2022]

Chen Z, Chen L, Yao G, Yang W, Yang K, Xiong C. Novel Blood Cytokine-Based Model for Predicting Severe Acute Kidney Injury and Poor Outcomes After Cardiac Surgery. J Am Heart Assoc 2020;9:e018004. [PMID: 33131359 PMCID: PMC7763725 DOI: 10.1161/jaha.120.018004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]

Abstract

Background Alterations in serum creatinine levels delay the identification of severe cardiac surgery-associated acute kidney injury. To provide timely diagnosis, novel predictive tools should be investigated. Methods and Results This prospective observational study consists of a screening cohort (n=204) and a validation cohort (n=198) from 2 centers from our hospital. Thirty-two inflammatory cytokines were measured via a multiplex cytokine assay. Least absolute shrinkage and selection operator regression was conducted to select the cytokine signatures of severe cardiac surgery-associated acute kidney injury. Afterwards, the significant candidates including interferon-γ, interleukin-16, and MIP-1α (macrophage inflammatory protein-1 alpha) were integrated into the logistic regression model to construct a predictive model. The predictive accuracy of the model was evaluated in these 2 cohorts. The cytokine-based model yielded decent performance in both the screening (C-statistic: 0.87, Brier 0.10) and validation cohorts (C-statistic: 0.86, Brier 0.11). Decision curve analysis revealed that the cytokine-based model had a superior net benefit over both the clinical factor-based model and the established plasma biomarker-based model for predicting severe acute kidney injury. In addition, elevated concentrations of each cytokine were associated with longer mechanical ventilation times, intensive care unit stays, and hospital stays. They strongly predicted the risk of composite events (defined as treatment with renal replacement therapy and/or in-hospital death) (OR of the fourth versus the first quartile [95% CI]: interferon-γ, 27.78 [3.61-213.84], interleukin-16, 38.07 [4.98-291.07], and MIP-1α, 9.13 [2.84-29.33]). Conclusions Our study developed and validated a promising blood cytokine-based model for predicting severe acute kidney injury after cardiac surgery and identified prognostic biomarkers for assisting in outcome risk stratification.

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Rasmussen SR, Kandler K, Nielsen RV, Jakobsen PC, Ranucci M, Ravn HB. Association between transfusion of blood products and acute kidney injury following cardiac surgery. Acta Anaesthesiol Scand 2020;64:1397-1404. [PMID: 32609377 DOI: 10.1111/aas.13664] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/05/2020] [Accepted: 06/13/2020] [Indexed: 12/19/2022]

Raina R, Joshi H, Chakraborty R. Changing the terminology from kidney replacement therapy to kidney support therapy. Ther Apher Dial 2020;25:437-457. [PMID: 32945598 DOI: 10.1111/1744-9987.13584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/16/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022]

Nguyen M, Tavernier A, Gautier T, Aho S, Morgant MC, Bouhemad B, Guinot PG, Grober J. Glucagon-like peptide-1 is associated with poor clinical outcome, lipopolysaccharide translocation and inflammation in patients undergoing cardiac surgery with cardiopulmonary bypass. Cytokine 2020;133:155182. [DOI: 10.1016/j.cyto.2020.155182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/08/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022]

Austin D, McCanny P, Aneman A. Post-operative renal failure management in mechanical circulatory support patients. ANNALS OF TRANSLATIONAL MEDICINE 2020;8:833. [PMID: 32793678 PMCID: PMC7396231 DOI: 10.21037/atm-20-1172] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]