Low-dose prostacyclin preserves renal function in high-risk patients after coronary bypass surgery.
OBJECTIVE
Renal failure after bypass is still a threatening problem prolonging hospital care and reducing overall survival. The following pilot study was aimed to analyze whether perioperative low-dose prostacyclin infusion is able to preserve renal function in a selected group of patients who according to a poor cardiac function were stratified as high risk for the development of renal failure after bypass.


METHODS
Prospective randomized study.


METHODS
Tertiary care university medical center.


METHODS
Thirty-four patients scheduled for primary cardiac bypass surgery were included in the study (prostacyclin n = 17, control n = 17). Inclusion criteria were normal renal function before surgery and a cardiac ejection fraction <40%.


METHODS
Low-dose prostacyclin (2 ng/kg/min) was added to the standard anesthetic protocol. Infusion was started immediately before surgery and was continued for a maximum of 48


RESULTS
Significant differences in the endogenous creatinine clearance were found between the prostacyclin and the control group. Whereas there was a significant drop in the creatinine clearance at 6 hrs after surgery in the control group with a prolonged recovery period, values in the prostacyclin group remained stable. Creatinine clearance before intervention was 100 +/- 22 mL/min in the control group and 91 +/- 22 mL/min in the prostacyclin group, values at 24 hr were 68 +/- 34 mL/min vs. 103 +/- 37 mL/min, respectively (p < .01). Significant findings in favor for the prostacyclin group were also found for urine output and the fractional excretion rate of sodium.


CONCLUSIONS
This first pilot study indicates that low-dose prostacyclin may be of substantial value for preserving renal function in high-risk patients after coronary bypass surgery.
Morgera
Stanislao
S
Department of Nephrology, University Hospital Charité, Berlin, Germany.
Woydt
Rajko
R
Kern
Hartmut
H
Schmutzler
Martin
M
DeJonge
Koen
K
Lun
Andreas
A
Rohde
Wolfgang
W
Konertz
Wolfgang
W
Kox
Wolfgang J
WJ
Neumayer
Hans-Hellmut
HH
D001026:Coronary Artery Bypass; D003404:Creatinine / Q000378:metabolism; D011464:Epoprostenol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies
D003404:Creatinine; D011464:Epoprostenol