title: Effect of normothermic cardiopulmonary bypass on renal injury in pediatric cardiac surgery: a randomized controlled trial.
abstract: OBJECTIVE
  Hypothermic cardiopulmonary bypass (CPB), although associated with a reduction in oxygen requirement, has a number of disadvantages including detrimental effects on enzymatic function, energy generation, and cellular integrity. Normothermic perfusion is potentially a more physiologic method to maintain the functional integrity of major organ systems. One of the aims of this trial was to compare the effect of normothermic and hypothermic CPB on renal injury in pediatric patients undergoing cardiac surgery.
  
  
  METHODS
  Fifty-nine children (median age, 78 months; interquartile range, 39-130) undergoing corrective cardiac surgery were randomized to either hypothermic (28°C) or normothermic (35°C-37°C) CPB. Urinary albumin, retinal binding protein (RBP) and N-acetyl-β-glucosaminidase (NAG) were measured preoperatively, end of CPB, 4, and 24 hours postoperatively and were expressed as a ratio of urinary creatinine. Serum creatinine was measured preoperatively, end of CPB, and 24 and 48 hours postoperatively. Results are expressed as a difference in means (normotheric - hypothermic) or as a ratio of geometric means (normothermic/hypothermic).
  
  
  RESULTS
  Baseline characteristics were similar in both groups. For these biochemical markers no significant interactions between treatment and postintervention time were found. Serum creatinine (-2.10; 95% confidence interval [CI], -6.51-2.31), RBP (ratio, 0.96; 95% CI, 0.65-1.41), and NAG (ratio, 0.86; 95% CI, 0.56-1.36) were similar in the 2 groups (P ≥ .34), but the urinary albumin was significantly lower in the normothermic group (ratio, 0.63; 95% CI, 0.42-0.95, P = .03).
  
  
  CONCLUSIONS
  Normothermic CPB is associated with similar renal impairment to hypothermic CPB in children undergoing heart surgery.
authors.affiliation: Bristol Royal Hospital for Children, University of Bristol, Bristol, United Kingdom. M.Caputo@bristol.ac.uk
authors.forename: Massimo
authors.initials: M
authors.lastname: Caputo
authors.forename: Nish
authors.initials: N
authors.lastname: Patel
authors.forename: Gianni D
authors.initials: GD
authors.lastname: Angelini
authors.forename: Paolo
authors.initials: P
authors.lastname: de Siena
authors.forename: Serban
authors.initials: S
authors.lastname: Stoica
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Parry
authors.forename: Chris A
authors.initials: CA
authors.lastname: Rogers
mesh_terms: D000118:Acetylglucosaminidase / Q000652:urine; D000419:Albuminuria / Q000209:etiology; D015415:Biomarkers / Q000097:blood / Q000652:urine; D001831:Body Temperature; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood / Q000652:urine; D004739:England; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects*; D007223:Infant; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology* / Q000652:urine; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003404:Creatinine; D000118:Acetylglucosaminidase