Effect of Iloprost on Renal Function in Patients Undergoing Coronary Artery Bypass Grafting: A Clinical Study

Abstract

Purpose: Renal dysfunction remains a serious complication of coronary artery bypass grafting (CABG) surgery and is associated with increased mortality and morbidity. To date, a number of different strategies, including new pharmacologic agents, off-pump and cardiopulmonary bypass techniques have been used to avoid it, but none of them proves the excellent result. Methods: Between April 2009 to September 2011, 185 consecutive patients with multivessel coronary artery disease undergoing elective CABG were included the study. Iloprost was given with the onset of rewarming period at a dose of 1.25-2.5 ng/kg/min and it was ended together with the ending of CPB in 94 patients and remaining were in the control group. Creatinine clearance (CCr) and GFR were measured at the time of hospitalisation and on day first and fifth postoperatively. Serum potassium level was determined every 6 hours, during the first 24 hours postoperatively, and every 12 hours for the next 72 hours, and glomerular filtration rate was estimated. Results: There was no statistically significant difference in preoperative comorbidity. There were no significant differences in postoperative morbidity or mortality between either of the two groups that completed the study. However, urine output during the operation was significantly higher in the study group. An increase in creatine levels was more common in the control group. Development of a new CCr less than 50 ml/min was also significantly higher in the control group, postoperatively. Conclusion: Our study demonstrates that prophylactic intravenous iloprost administration after initiation of a rewarming period during CPB in patients undergoing CABG surgery is associated with improved renal function, compared with conventional treatment in wellhydrated patients. It also has a good safety profile and is generally well tolerated.

A Review of the Use of Iloprost, A Synthetic Prostacyclin, in the Prevention of Radiocontrast Nephropathy in Patients Undergoing Coronary Angiography and Intervention

“…These mechanisms are demonstrated with an accelerated drop in plasma creatinine in renal transplant patients . Similarly, acute renal insufficiency following cardiopulmonary bypass is attributed to hypoperfusion, as well as excessive levels of circulating cytokines . Intraoperative Iloprost administration was efficacious in maintaining creatinine levels within 25% of preoperative baseline values.…”

“…Four were duplicate RCTs, and 5 did not occur in the setting of coronary angiography; 3 studies investigated the use of prostacyclins and calcium antagonists in cyclosporine‐induced renal failure among patients who underwent renal transplantation . One study reported protective effects of iloprost in the coronary artery bypass grafting setting . Two studies reported on iloprost and CIN and coronary angiography (Figure ) …”

“…6,8 -11 One study reported protective effects of iloprost in the coronary artery bypass grafting setting. 5 Two studies reported on iloprost and CIN and coronary angiography ( Figure 2). 12,13 They each have Jadad scores of 4, prompting further statistical analyses by the authors (Table 1 and Figure 3).…”

“…There are little data comparing pharmacological interventions to placebo without volume expansion. Prostaglandins have been shown to be effective in preventing renal dysfunction in patients undergoing renal transplant and recently coronary artery bypass grafting, and by presumed similar mechanisms, reducing CIN among patients undergoing coronary angiography …”

Kidney dysfunction in patients with pulmonary arterial hypertension

“…71 In patients undergoing coronary artery bypass grafting, prophylactic Iloprost administration was associated with significantly improved urine output and decreased serum creatinine. 72 Administration of Iloprost in patients with inoperable limb ischemia and kidney dysfunction (CKD stage 2) was associated with improvements in serum creatinine and eGFR. 73 Similarly, long-term administration of Beraprost in patients with diabetic CKD was shown to decrease urinary albumin excretion.…”