Effect of uric acid lowering therapy on the prevention of acute kidney injury in cardiovascular surgery.
OBJECTIVE
Serum uric acid (SUA) is a novel risk factor for acute kidney injury (AKI), which adversely affects renal blood flow autoregulation, glomerular filtration rate (GFR), and promotes inflammation and angiogenesis. This pilot study investigated the effect of lowering SUA therapy on AKI, by using traditional and non-traditional markers.


METHODS
In this prospective, double-blind, placebo-controlled, randomized pilot trial, 26 hyperuricemic patients undergoing cardiac surgery were randomized to receive rasburicase or placebo in the preoperative period.


RESULTS
Subjects receiving rasburicase showed no difference in serum creatinine compared with the control group receiving placebo. Despite no difference in primary endpoint, the rasburicase group had less evidence of renal structural injury as reflected by urine neutrophil-associated lipocalin (uNGAL) concentrations, especially in subjects with higher SUA levels, more severe renal dysfunction (baseline GFR ≤ 45 mL/min/1.73 m(2)) or heart failure (left ventricular ejection fraction ≤45 %).


CONCLUSIONS
In this study, rasburicase showed no benefit on postoperative serum creatinine in hyperuricemic subjects undergoing cardiac surgery. However, the observation that markers of structural renal injury such as uNGAL tended to be lower in rasburicase-treated subjects suggests potential different effects of uricase treatment on hemodynamic alterations in renal function versus structural mechanisms of kidney injury.
Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL, USA. ejazaa@medicine.ufl.edu
A Ahsan
AA
Ejaz
Bhagwan
B
Dass
Vijaykumar
V
Lingegowda
Michiko
M
Shimada
Thomas M
TM
Beaver
Noel I
NI
Ejaz
Amer S
AS
Abouhamze
Richard J
RJ
Johnson
D058186:Acute Kidney Injury / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D014503:Urate Oxidase / Q000627:therapeutic use*; D014527:Uric Acid / Q000097:blood*
C469709:rasburicase; D014527:Uric Acid; D014503:Urate Oxidase