Diltiazem may preserve renal tubular integrity after cardiac surgery.
OBJECTIVE
To evaluate the influence of dopamine and diltiazem on renal function and markers for acute renal failure, including urinary alpha-glutathion s-transferase (alpha-GST), alpha-1-microglobulin (alpha(1)-MG) and N-acetyl-ss-glucosaminidase (ss-NAG) after extracorporeal circulation.


METHODS
In a randomized, placebo-controlled, double-blind trial we evaluated the efficacy of dopamine (2.5 micro g x kg(-1) x min(-1)), diltiazem (2 micro g x kg(-1) x min(-1)) or placebo administered over 48 hr postoperatively to maintain renal tubular integrity in 60 elective cardiac surgery patients. alpha-GST, alpha(1)-MG, ss-NAG, and creatinine clearance were measured from urine collected during surgery (T0), the first four hours (T1), 24 hr (T2) and 48 hr (T3) postoperatively.


RESULTS
Cumulative urine output in the diltiazem group (9.0 +/- 2.8 L) increased significantly compared with placebo (7.0 +/- 1.6 L), but not compared with dopamine (7.8 +/- 1.8 L). Creatinine clearance showed no significant intergroup differences. In all groups alpha(1)-MG increased from T0 to T3, but we found no significant intergroup differences. alpha-GST increased significantly from T0 to T3 in the placebo (2.1 +/- 1.8 to 11.4 +/- 8.6 micro g x L(-1)) and in the dopamine groups (2.7 +/- 1.8 to 13.6 +/- 14.9 micro g x L(-1)), but not in the diltiazem group (1.8 +/- 1.4 to 3.2 +/- 3.2 micro g x L(-1)). Forty-eight hours postoperatively alpha-GST was significantly lower in the diltiazem group than in both other groups.


CONCLUSIONS
Diltiazem stimulates urine output, reduces excretion of alpha-GST and ss-NAG and may be useful to maintain tubular integrity after cardiac surgery.
Piper
Swen N
SN
Department of Anesthesiology and Critical Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany. swen.n.piper@t-online.de
Kumle
Bernhard
B
Maleck
Wolfgang H
WH
Kiessling
Arndt-Holger
AH
Lehmann
Andreas
A
Röhm
Kerstin D
KD
Suttner
Stefan W
SW
Boldt
Joachim
J
D000118:Acetylglucosaminidase / Q000652:urine; D058186:Acute Kidney Injury / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D002121:Calcium Channel Blockers / Q000494:pharmacology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D004110:Diltiazem / Q000494:pharmacology*; D004231:Diuresis / Q000187:drug effects; D004298:Dopamine / Q000494:pharmacology; D004311:Double-Blind Method; D005260:Female; D005982:Glutathione Transferase / Q000652:urine; D006801:Humans; D007684:Kidney Tubules / Q000187:drug effects*; D008297:Male; D008875:Middle Aged
D002121:Calcium Channel Blockers; D005982:Glutathione Transferase; D000118:Acetylglucosaminidase; D004110:Diltiazem; D004298:Dopamine