Diltiazem infusion for renal protection in cardiac surgical patients with preexisting renal dysfunction.
OBJECTIVE
To evaluate if the calcium channel blocker diltiazem protects postoperatively renal function in cardiac surgical patients with preexisting mild-to-moderate renal dysfunction.


METHODS
Prospective, randomized, placebo-controlled, double-blind, clinical study.


METHODS
Cardiothoracic anesthesia department at a university hospital.


METHODS
Adult patients undergoing elective cardiac surgery using cardiopulmonary bypass, with a preoperatively elevated serum creatinine level (n = 24).


METHODS
Randomized infusions of diltiazem (bolus 0.25 mg/kg followed by a continuous infusion of 1.7 microg/kg/min) (DTZ, n = 12) or placebo (C, n = 12) were started 30 minutes before induction of anesthesia and continued for 24 hours.


RESULTS
Median plasma concentrations of diltiazem (DTZ group) were 79 microg/L before cardiopulmonary bypass, 67 microg/L at the end of cardiopulmonary bypass, and 164 microg/L at 24 hours postoperatively. Serum creatinine levels; on postoperative days 1, 3, and 5; and 3 weeks postoperatively were similar between groups. Iohexol clearance did not differ between the groups on day 5 but was higher in the DTZ group than in the placebo group 3 weeks after surgery (median, 51 v 40 mL/min/1.73 m(2); p < 0.05). Urinary N-acetyl-beta-glucosamidase concentrations were similar between the groups during the study but were increased from baseline on days 2 and 4 and 3 weeks postoperatively.


CONCLUSIONS
Diltiazem can be safely used in patients who have mild-to-moderate renal dysfunction and undergo cardiac surgery using cardiopulmonary bypass. Within the limits of this study, the data suggest that addition of prophylactic diltiazem may prevent further glomerular damage resulting from cardiopulmonary bypass and may improve glomerular function 3 weeks after cardiac surgery.
Bergman
Anders S F
AS
Department of Anaesthesiology and Intensive Care, Department of Clinical Chemistry, Department of Medicine, Division of Nephrology, and Department of Cardiothoracic Anaesthetics and Intensive Care, Karolinska Hospital and Institute, Stockholm, Sweden.
Odar-Cederlöf
Ingegerd
I
Westman
Lars
L
Bjellerup
Per
P
Höglund
Peter
P
Ohqvist
Gun
G
D000118:Acetylglucosaminidase / Q000652:urine; D000368:Aged; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass; D003404:Creatinine / Q000097:blood; D004110:Diltiazem / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007262:Infusions, Intravenous; D007472:Iohexol / Q000493:pharmacokinetics; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D011446:Prospective Studies; D020011:Protective Agents / Q000008:administration & dosage*
D002121:Calcium Channel Blockers; D020011:Protective Agents; D007472:Iohexol; D003404:Creatinine; D000118:Acetylglucosaminidase; D004110:Diltiazem