Leukodepletion reduces renal injury in coronary revascularization: a prospective randomized study.
BACKGROUND
Cardiopulmonary bypass (CPB) is an important contributor to renal failure, which is a well-recognized complication after coronary artery bypass grafting (CABG). Leukodepletion reduces CPB-associated inflammation and resultant end-organ injuries. However, its effectiveness in renal protection has not been evaluated in a prospective randomized clinical setting.


METHODS
Forty low-risk patients awaiting elective CABG with normal preoperative cardiac and renal function were prospectively randomized into those undergoing nonpulsatile CPB without (group A: n = 20) and with leukodepletion (group B: n = 20). Renal glomerular and tubular injury were assessed by urinary excretion of microalbumin and retinol binding protein (RBP) indexed to creatinine (Cr), respectively. Daily measurements were taken from admission to postoperative day 5. Fluid balance, serum creatinine, and blood urea were also monitored.


RESULTS
No mortality or renal complication occurred. Both groups had similar demographic makeups, Parsonnet scores, extents of coronary revascularization and, durations of CPB and aortic cross-clamping. Daily fluid balance, serum creatinine, and blood urea remained comparable in both groups throughout the study period. From equal preoperative values, a significantly higher release of urinary RBP:Cr (7,807 +/- 2,227 vs 3,942 +/- 2,528; p < 0.001) and urinary microalbumin:Cr (59.4 +/- 38.0 vs 4.7 +/- 6.7; p < 0.0001) occurred in group A, peaking on day 1 before returning to approximate baseline levels.


CONCLUSIONS
Although clinically overt renal complications were absent, sensitive indicators revealed significantly more injury to both renal tubules and glomeruli after nonpulsatile CPB without leukodepletion. These data suggest that leukocytes play an important role in post-CPB renal dysfunction, and leukodepletion may offer some renal protection in low-risk patients during CABG.
Tang
Augustine T M
AT
Wessex Regional Cardiac and Thoracic Unit, Southampton General Hospital, United Kingdom. gus@tang-family.org
Alexiou
Christos
C
Hsu
Jeff
J
Sheppard
Stuart V
SV
Haw
Marcus P
MP
Ohri
Sunil K
SK
D000368:Aged; D015415:Biomarkers / Q000032:analysis; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006440:Hemofiltration; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D015415:Biomarkers