title: Comparison of renal perfusion solutions during thoracoabdominal aortic aneurysm repair.
abstract: BACKGROUND
  To determine whether renal perfusion with cold crystalloid solution enriched with histidine-tryptophan-ketoglutarate (Custodiol; Dr Franz-Kohler Chemie GmbH, Bensheim, Germany) provides better protection against renal ischemic injury than cold lactated Ringer's solution in patients undergoing thoracoabdominal aortic aneurysm open repair.
  
  
  METHODS
  We analyzed a prospectively compiled database containing all 111 consecutive patients who underwent thoracoabdominal aortic aneurysm open repair at our center from 2008 to 2011. A cohort of 104 consecutive patients was identified of which 50 (48%) had renal perfusion with Custodiol and 54 (52%) with lactated Ringer's solution. Propensity score matching based on baseline clinical variables, which were expected to influence renal outcomes, was performed to correct for any bias that may have been associated with the use of Custodiol. Acute kidney injury (AKI) as defined by Kidney Disease Improving Global Outcomes guidelines and perioperative estimated glomerular filtration rate were compared in the two groups. Independent predictors of AKI were also identified by multivariate analysis.
  
  
  RESULTS
  After propensity score matching, we were able to match 42 Custodiol cases one-to-one with those receiving perfusion with lactated Ringer's solution. Overall 30-day mortality was 5.9%; temporary hemodialysis or continuous veno-venous hemofiltration was needed in 4.8% of the patients without any case of dialysis at discharge. Freedom from AKI was significantly increased in the Custodiol group (38.1% vs 9.5%; P = .002) despite longer total renal ischemic time (51.5 ± 16.4 minutes vs 43.6 ± 16.0 minutes; P = .05). By analysis of variance for repeated measures, a significant upward trend of perioperative estimated glomerular filtration rate was observed in the Custodiol group (group × time interaction = F3,66; P < .001), and by multivariate analysis, Custodiol perfusion was the only independent predictor of non-AKI (P = .04).
  
  
  CONCLUSIONS
  The use of Custodiol was safe and provided improved perioperative renal function compared with lactated Ringer's solution. Randomized trials are needed to confirm these data and to assess their clinical consequences.
authors.affiliation: Vascular Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy. Electronic address: y.tshomba@hsr.it.
authors.forename: Yamume
authors.initials: Y
authors.lastname: Tshomba
authors.affiliation: Vascular Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kahlberg
authors.affiliation: Vascular Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Germano
authors.initials: G
authors.lastname: Melissano
authors.affiliation: Vascular Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Coppi
authors.affiliation: Vascular Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Marone
authors.affiliation: Vascular Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Denise
authors.initials: D
authors.lastname: Ferrari
authors.affiliation: Anesthesia and Intensive Care, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Rosalba
authors.initials: R
authors.lastname: Lembo
authors.affiliation: Vascular Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Chiesa
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000453:epidemiology / Q000601:surgery*; D003080:Cold Temperature; D005260:Female; D005919:Glomerular Filtration Rate; D005947:Glucose / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008353:Mannitol / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010477:Perfusion / Q000009:adverse effects / Q000379:methods*; D011189:Potassium Chloride / Q000008:administration & dosage / Q000009:adverse effects; D015995:Prevalence; D011343:Procaine / Q000008:administration & dosage / Q000009:adverse effects; D057216:Propensity Score; D006435:Renal Dialysis; D015427:Reperfusion Injury / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D012189:Retrospective Studies; D000077325:Ringer's Lactate; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: C039984:Bretschneider cardioplegic solution; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D005947:Glucose