title: The effects of pulsatile cardiopulmonary bypass on acute kidney injury.
abstract: OBJECTIVE
  Protective effect of pulsatile flow cardiopulmonary bypass (CPB) on the occurrence of acute renal injury is still a matter of debate. The objective of this study was to compare the effects of pulsatile and non-pulsatile cardiopulmonary bypass on kidneys using Urinary neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) as the markers of renal injury.
  
  
  METHODS
  85 consecutive patients with normal preoperative renal function were prospectively enrolled in the study. Pulsatile perfusion (Group P) and non-pulsatile perfusion (Group NP) was used in 42 and 43 of the patients, respectively, during aortic cross-clamping period. NGAL and IL-18 were analyzed using ELISA in urine samples obtained preoperatively, and at 2, 12, and 24 h after CPB.
  
  
  RESULTS
  There was no significant difference between the groups in terms of perioperative renal function tests. IL-18 levels measured at 12 h after CPB were significantly lower in Group P, compared to Group NP (p<0.05). Urinary NGAL levels measured at 2 and 12 h were higher in Group NP; however, the difference was insignificant. In the subgroup of patients with a cross clamp time ≥45 minutes (pulsatile CPB, group P1, n = 33; non-pulsatile CPB, group NP1, n = 33), IL-18 levels measured at 12 hours after CPB were significantly lower in Group P1. Urinary NGAL concentrations measured at 2 and 12 hours in Group P1 were also significantly lower than that in Group NP1 (p = 0.048 and 0.043, respectively).
  
  
  CONCLUSIONS
  Low IL-18 and NGAL levels found in the pulsatile perfusion group might suggest the use of pulsatile flow resulted in better kidney protection.
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu Advanced Training and Research Hospital, Istanbul, Turkey. taylanadademir@gmail.com
authors.forename: Taylan
authors.initials: T
authors.lastname: Adademir
authors.forename: Koray
authors.initials: K
authors.lastname: Ak
authors.forename: Maher
authors.initials: M
authors.lastname: Aljodi
authors.forename: Mehmet Emre
authors.initials: ME
authors.lastname: Elçi
authors.forename: Sinan
authors.initials: S
authors.lastname: Arsan
authors.forename: Selim
authors.initials: S
authors.lastname: Isbir
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine*; D000328:Adult; D000368:Aged; D001011:Aorta / Q000503:physiopathology / Q000601:surgery; D015415:Biomarkers / Q000652:urine; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D003250:Constriction; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D020382:Interleukin-18 / Q000652:urine*; D007677:Kidney Function Tests; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000652:urine*; D011673:Pulsatile Flow; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins