Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-20T17:38:47.207Z Has data issue: false hasContentIssue false
  • English
  • Français

Renal function after cardiopulmonary bypass surgery in patients with impaired renal function. A randomized study of the effect of nifedipine

Published online by Cambridge University Press:  01 April 2008

B. J. Witczak ,
A. Hartmann ,
O. R. Geiran  and
J. F. Bugge
B. J. Witczak*
Affiliation:
University of Oslo, Rikshospitalet, Department of Internal Medicine, Section of Nephrology, Oslo, Norway University of Oslo, Rikshospitalet, Laboratory for Renal Physiology, Oslo, Norway
A. Hartmann
Affiliation:
University of Oslo, Rikshospitalet, Department of Internal Medicine, Section of Nephrology, Oslo, Norway University of Oslo, Rikshospitalet, Laboratory for Renal Physiology, Oslo, Norway
O. R. Geiran
Affiliation:
University of Oslo, Rikshospitalet, Department of Thoracic Surgery, Oslo, Norway
J. F. Bugge
Affiliation:
University of Oslo, Rikshospitalet, Department of Anesthesiology, Oslo, Norway
*
Correspondence to: Bartlomiej J. Witczak, Department of Internal Medicine, Section of Nephrology, Rikshospitalet, University of Oslo, 0027 Oslo, Norway. E-mail: [email protected]; Tel: +47 23 07 00 00; Fax: +47 23 07 38 65
Get access

Summary

Background and objectives

Postoperative acute renal failure predicts morbidity and mortality. We investigated the effect of nifedipine infusion on glomerular filtration rate in patients with impaired renal function undergoing cardiopulmonary bypass surgery.

Methods

Twenty patients accepted for coronary bypass and/or heart valve surgery were enrolled prospectively and randomized to nifedipine infusion or no treatment. Males and females with creatinine ⩾150 μmol L−1 and ⩾130 μmol L−1, respectively, were included. Patients with unstable angina pectoris, ejection fraction ⩽35% and those on dialysis were excluded. Glomerular filtration rate was measured preoperatively and 48 h postoperatively. Creatinine clearance was measured preoperatively and 0–4, 20–24 and 44–48 h postoperatively. There were no statistically significant differences in patient characteristics. Biochemical markers in plasma and urine were measured before and 48 h after surgery.

Results

The mean ± SD preoperative glomerular filtration rates were 32.2 ± 11.5 and 31.4 ± 17.0 mL min−1 per 1.73 m2 in the nifedipine and control groups (P = 0.90), respectively. There was no statistically significant change in the glomerular filtration rate or in creatinine clearance over time within or between groups. A linear mixed model showed no effect of nifedipine (P = 0.44), time (P = 0.97) or interaction of nifedipine and time (P = 0.99) on creatinine clearance. Perioperative arterial pressure was kept within predefined targets. Three patients received dialysis postoperatively, all in the control group (P = 0.21). There were no statistically significant differences between groups in changes of urinary or plasma biochemistry.

Conclusions

Renal function was well preserved after cardiopulmonary bypass surgery in patients with impaired renal function when maintaining thorough intensive care surveillance. Nifedipine did not influence early postoperative renal function.

Keywords

CARDIAC SURGERYCARDIOPULMONARY BYPASSKIDNEY FAILURECHRONICHETEROCYCLIC COMPOUNDS, nifedipineINVESTIGATIVE TECHNIQUES, randomized-controlled trials
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 4 , April 2008 , pp. 319 - 325
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Chertow, GM, Levy, EM, Hammermeister, KE, Grover, F, Daley, J. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 1998; 104 (4): 343–348.CrossRefGoogle ScholarPubMed
2.Mehta, RH, Grab, JD, O’Brien, SM et al. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation 2006; 114 (21): 2208–2216.Google Scholar
3.Hein, OV, Birnbaum, J, Wernecke, KD, Konertz, W, Jain, U, Spies, C. Three-year survival after four major post-cardiac operative complications. Crit Care Med 2006; 34 (11): 2729–2737.CrossRefGoogle ScholarPubMed
4.Lassnigg, A, Schmidlin, D, Mouhieddine, M et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol 2004; 15 (6): 1597–1605.Google Scholar
5.Wang, F, Dupuis, JY, Nathan, H, Williams, K. An analysis of the association between preoperative renal dysfunction and outcome in cardiac surgery: estimated creatinine clearance or plasma creatinine level as measures of renal function. Chest 2003; 124 (5): 1852–1862.CrossRefGoogle ScholarPubMed
6.Brown, JR, Cochran, RP, Dacey, LJ et al. Perioperative increases in serum creatinine are predictive of increased 90-day mortality after coronary artery bypass graft surgery. Circulation 2006; 114 (Suppl 1): I409–I413.Google Scholar
7.Anderson, RJ, O’Brien, M, MaWhinney, S et al. Mild renal failure is associated with adverse outcome after cardiac valve surgery. Am J Kidney Dis 2000; 35 (6): 1127–1134.CrossRefGoogle ScholarPubMed
8.Weerasinghe, A, Hornick, P, Smith, P, Taylor, K, Ratnatunga, C. Coronary artery bypass grafting in non-dialysis-dependent mild-to-moderate renal dysfunction. J Thorac Cardiovasc Surg 2001; 121 (6): 1083–1089.CrossRefGoogle ScholarPubMed
9.Mazzarella, V, Gallucci, MT, Tozzo, C et al. Renal function in patients undergoing cardiopulmonary bypass operations. J Thorac Cardiovasc Surg 1992; 104 (6): 1625–1627.CrossRefGoogle ScholarPubMed
10.Bergman, AS, Odar-Cederlof, I, Westman, L, Bjellerup, P, Hoglund, P, Ohqvist, G. Diltiazem infusion for renal protection in cardiac surgical patients with preexisting renal dysfunction. J Cardiothorac Vasc Anesth 2002; 16 (3): 294–299.CrossRefGoogle ScholarPubMed
11.Costa, P, Ottino, GM, Matani, A et al. Low-dose dopamine during cardiopulmonary bypass in patients with renal dysfunction. J Cardiothorac Anesth 1990; 4 (4): 469–473.CrossRefGoogle ScholarPubMed
12.Bove, T, Landoni, G, Calabro, MG et al. Renoprotective action of fenoldopam in high-risk patients undergoing cardiac surgery: a prospective, double-blind, randomized clinical trial. Circulation 2005; 111 (24): 3230–3235.Google Scholar
13.Neumayer, HH, Kunzendorf, U, Schreiber, M. Protective effects of calcium antagonists in human renal transplantation. Kidney Int Suppl 1992; 36: S87–S93.Google Scholar
14.Jacobsen, WK, Cole, DJ, Stewart, SC et al. Effect of calcium entry blocker nitrendipine on renal function after renal vascular occlusion. Crit Care Med 1990; 18 (12): 1403–1407.CrossRefGoogle ScholarPubMed
15.Taira, N. Differences in cardiovascular profile among calcium antagonists. Am J Cardiol 1987; 59 (3): 24B–29B.Google Scholar
16.Hilbrands, LB, Artz, MA, Wetzels, JF, Koene, RA. Cimetidine improves the reliability of creatinine as a marker of glomerular filtration. Kidney Int 1991; 40 (6): 1171–1176.Google Scholar
17.van Acker, BA, Koomen, GC, Koopman, MG, de Waart, DR, Arisz, L. Creatinine clearance during cimetidine administration for measurement of glomerular filtration rate. Lancet 1992; 340 (8831): 1326–1329.Google Scholar
18.Bertolissi, M, Antonucci, F, De, MA, Padovani, R, Giordano, F. Effects on renal function of a continuous infusion of nifedipine during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1996; 10 (2): 238–242.CrossRefGoogle ScholarPubMed
19.Levy, JH, Tanaka, KA. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 2003; 75 (2): S715–S720.CrossRefGoogle ScholarPubMed
20.Asimakopoulos, G. Systemic inflammation and cardiac surgery: an update. Perfusion 2001; 16 (5): 353–360.Google Scholar
21.De, SF, Francois, K, van, OW et al. Phosphorylcholine coating of extracorporeal circuits provides natural protection against blood activation by the material surface. Eur J Cardiothorac Surg 2000; 18 (5): 602–606.Google Scholar
22.De, SF, Van, BY, Caes, F et al. Phosphorylcholine coating offers natural platelet preservation during cardiopulmonary bypass. Perfusion 2002; 17 (1): 39–44.Google Scholar
23.Urzua, J, Troncoso, S, Bugedo, G et al. Renal function and cardiopulmonary bypass: effect of perfusion pressure. J Cardiothorac Vasc Anesth 1992; 6 (3): 299–303.CrossRefGoogle ScholarPubMed
24.Zanardo, G, Michielon, P, Rosi, P et al. Effects of a continuous diltiazem infusion on renal function during cardiac surgery. J Cardiothorac Vasc Anesth 1993; 7 (6): 711–716.CrossRefGoogle ScholarPubMed
25.Amano, J, Suzuki, A, Sunamori, M, Tofukuji, M. Effect of calcium antagonist diltiazem on renal function in open heart surgery. Chest 1995; 107 (5): 1260–1265.CrossRefGoogle ScholarPubMed
26.Yavuz, S, Ayabakan, N, Goncu, MT, Ozdemir, IA. Effect of combined dopamine and diltiazem on renal function after cardiac surgery. Med Sci Monit 2002; 8 (5): I45–I50.Google Scholar
27.Manabe, S, Tanaka, H, Yoshizaki, T, Tabuchi, N, Arai, H, Sunamori, M. Effects of the postoperative administration of diltiazem on renal function after coronary artery bypass grafting. Ann Thorac Surg 2005; 79 (3): 831–835.CrossRefGoogle ScholarPubMed
28.Piper, SN, Kumle, B, Maleck, WH et al. Diltiazem may preserve renal tubular integrity after cardiac surgery. Can J Anaesth 2003; 50 (3): 285–292.CrossRefGoogle ScholarPubMed
29.Zacharias, M, Gilmore, IC, Herbison, GP, Sivalingam, P, Walker, RJ. Interventions for protecting renal function in the perioperative period. Cochrane Database Syst Rev 2005(3): CD003590.Google ScholarPubMed
30.Kaya, K, Oguz, M, Akar, AR et al. The effect of sodium nitroprusside infusion on renal function during reperfusion period in patients undergoing coronary artery bypass grafting: a prospective randomized clinical trial. Eur J Cardiothorac Surg 2007; 31 (2): 290–297.Google Scholar