Renal function after cardiopulmonary bypass surgery in patients with impaired renal function. A randomized study of the effect of nifedipine.
OBJECTIVE
Postoperative acute renal failure predicts morbidity and mortality. We investigated the effect of nifedipine infusion on glomerular filtration rate in patients with impaired renal function undergoing cardiopulmonary bypass surgery.


METHODS
Twenty patients accepted for coronary bypass and/or heart valve surgery were enrolled prospectively and randomized to nifedipine infusion or no treatment. Males and females with creatinine 150 micromol L(-1) and 130 micromol L(-1), respectively, were included. Patients with unstable angina pectoris, ejection fraction 35% and those on dialysis were excluded. Glomerular filtration rate was measured preoperatively and 48 h postoperatively. Creatinine clearance was measured preoperatively and 0-4, 20-24 and 44-48 h postoperatively. There were no statistically significant differences in patient characteristics. Biochemical markers in plasma and urine were measured before and 48 h after surgery.


RESULTS
The mean +/- SD preoperative glomerular filtration rates were 32.2 +/- 11.5 and 31.4 +/- 17.0 mL min-1 per 1.73 m2 in the nifedipine and control groups (P = 0.90), respectively. There was no statistically significant change in the glomerular filtration rate or in creatinine clearance over time within or between groups. A linear mixed model showed no effect of nifedipine (P = 0.44), time (P = 0.97) or interaction of nifedipine and time (P = 0.99) on creatinine clearance. Perioperative arterial pressure was kept within predefined targets. Three patients received dialysis postoperatively, all in the control group (P = 0.21). There were no statistically significant differences between groups in changes of urinary or plasma biochemistry.


CONCLUSIONS
Renal function was well preserved after cardiopulmonary bypass surgery in patients with impaired renal function when maintaining thorough intensive care surveillance. Nifedipine did not influence early postoperative renal function.
Witczak
B J
BJ
University of Oslo, Rikshospitalet, Laboratory for Renal Physiology, Oslo, Norway. bartlomiej.witczak@rikshospitalet.no
Hartmann
A
A
Geiran
O R
OR
Bugge
J F
JF
D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000494:pharmacology*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood / Q000652:urine; D003422:Critical Care; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000494:pharmacology*; D011446:Prospective Studies; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications*; D013997:Time Factors
D002121:Calcium Channel Blockers; D003404:Creatinine; D009543:Nifedipine