title: Renal Function and Urinary Biomarkers in Cardiac Bypass Surgery: A Prospective Randomized Trial Comparing Three Surgical Techniques.
abstract: BackgroundCardiopulmonary bypass procedure is associated with an increased risk of renal impairment. To which extent structural damage causes functional decline is unknown. We evaluated perioperative kidney injury and function in patients treated with conventional extracorporeal circulation (CECC), minimized extracorporeal circulation (MECC), and off-pump coronary artery bypass grafting (OPCAB).MethodsBlood and urine samples, collected at baseline and up to 72 hours after surgery from patients of the HEPCON trial (DRKS00007580, 120 patients randomized for heparin management and for surgical technique), were analyzed for differences in renal injury and function. Neutrophil gelatinase-associated lipocalin, α glutathione S-transferase, liver fatty acid-binding protein, and kidney injury molecule-1 were measured as urinary protein markers of renal tubular injury. Serum creatinine, blood urea levels, and estimated glomerular filtration rate were determined to monitor renal function.ResultsMarkers of tubular injury differed significantly between surgical technique groups early after surgery, indicating the most detrimental effect in CECC. Hemolysis and hemodilution correlated with these early changes. A late rise did not show intergroup differences. Time courses of renal function parameters, as well as the development of acute kidney injury in 15 patients (13.5%), were irrespective of surgical technique. Heparin management did not influence renal parameters.ConclusionDuring coronary artery bypass grafting, CECC temporarily induces more tubular injury than MECC or OPCAB. However, late changes of renal function parameters occur irrespective of extracorporeal perfusion mode and even in off-pump surgery.
authors.affiliation: Department of Cardio-Thoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Deininger
authors.affiliation: Department of Cardio-Thoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Hoenicka
authors.affiliation: Department of Cardio-Thoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany.
authors.forename: Kristina
authors.initials: K
authors.lastname: Müller-Eising
authors.affiliation: Department of Cardio-Thoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany.
authors.forename: Patricia
authors.initials: P
authors.lastname: Rupp
authors.affiliation: Department of Cardio-Thoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Liebold
authors.affiliation: Department of Internal Medicine II - Cardiology, University of Ulm Medical Center, Ulm, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koenig
authors.affiliation: Department of Cardio-Thoracic and Vascular Surgery, University of Ulm Medical Center, Ulm, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Gorki
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000652:urine; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D050556:Fatty Acid-Binding Proteins / Q000652:urine; D005260:Female; D005858:Germany; D005919:Glomerular Filtration Rate; D005982:Glutathione Transferase / Q000652:urine; D006493:Heparin / Q000008:administration & dosage; D000072596:Hepatitis A Virus Cellular Receptor 1 / Q000378:metabolism; D006801:Humans; D007527:Isoenzymes / Q000652:urine; D007668:Kidney / Q000503:physiopathology*; D000071068:Lipocalin-2 / Q000652:urine; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; C493319:FABP1 protein, human; D050556:Fatty Acid-Binding Proteins; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; D007527:Isoenzymes; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D006493:Heparin; D005982:Glutathione Transferase; C119995:glutathione S-transferase alpha