Effects of acute plasma volume expansion on renal perfusion, filtration, and oxygenation after cardiac surgery: a randomized study on crystalloid vs colloid

Larsson, J. Skytte; Bragadottir, Gudrun; Krumbholz, V.; Redfors, Bengt; Sellgren, Johan; Ricksten, Sven‐Erik

doi:10.1093/bja/aev346

Cited by 35 publications

(22 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One could argue that norepinephrine would induce a renal vasoconstriction redistributing CI from the kidneys. In this study, the RBF/CI ratio was ≈20%, which is somewhat lower than previously described in uncomplicated post‐operative patients, in whom the RBF/CI ratio was 27% . This redistribution is, however, unlikely to be explained by a norepinephrine‐induced renal vasoconstriction, as RBF and GFR improved while RVR was unchanged when MAP was changed from 60 to 75 mm Hg, as shown in this study.…”

Section: Discussionsupporting

confidence: 47%

See 1 more Smart Citation

Renal effects of norepinephrine‐induced variations in mean arterial pressure after liver transplantation: A randomized cross‐over trial

Larsson

Bragadottir

Redfors

et al. 2018

Acta Anaesthesiol Scand

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 47%

“…The central position of the catheter in the renal vein was confirmed by venography using ultra‐low doses of iohexol, 5‐15 mg I/kg (Omnipaque 300 mg I/mL; GE Healthcare, Stockholm, Sweden). The continuous retrograde thermodilution technique was used to measure RBF (in triplicate) . An i.v.…”

Section: Methodsmentioning

confidence: 99%

Renal effects of norepinephrine‐induced variations in mean arterial pressure after liver transplantation: A randomized cross‐over trial

Larsson

Bragadottir

Redfors

et al. 2018

Acta Anaesthesiol Scand

Self Cite

View full text Add to dashboard Cite

show abstract

“…They also found, in patients without AKI, that crystalloid (Ringer's lactate) but not colloid (Venofundin â ) increased renal fractional oxygen extraction, presumably by increasing GFR. 116 Collectively, the observations described in the paragraph above show that therapies aimed at improving GFR in patients with post-operative AKI should be administered with caution, and with consideration of the likely effects of these treatments on the renal oxygen supply/demand relationship. These findings also provide important guidance for intensivists with regard to the appropriate choice of therapies to optimize global renal oxygenation.…”

Section: Potential Interventions To Ameliorate the Consequences Of mentioning

confidence: 99%

Renal haemodynamics and oxygenation during and after cardiac surgery and cardiopulmonary bypass

et al. 2017

View full text Add to dashboard Cite

Acute kidney injury (AKI) is a common complication following cardiac surgery performed on cardiopulmonary bypass (CPB) and has important implications for prognosis. The aetiology of cardiac surgery-associated AKI is complex, but renal hypoxia, particularly in the medulla, is thought to play at least some role. There is strong evidence from studies in experimental animals, clinical observations and computational models that medullary ischaemia and hypoxia occur during CPB. There are no validated methods to monitor or improve renal oxygenation during CPB, and thus possibly decrease the risk of AKI. Attempts to reduce the incidence of AKI by early transfusion to ameliorate intra-operative anaemia, refinement of protocols for cooling and rewarming on bypass, optimization of pump flow and arterial pressure, or the use of pulsatile flow, have not been successful to date. This may in part reflect the complexity of renal oxygenation, which may limit the effectiveness of individual interventions. We propose a multi-disciplinary pathway for translation comprising three components. Firstly, large-animal models of CPB to continuously monitor both whole kidney and regional kidney perfusion and oxygenation. Secondly, computational models to obtain information that can be used to interpret the data and develop rational interventions. Thirdly, clinically feasible non-invasive methods to continuously monitor renal oxygenation in the operating theatre and to identify patients at risk of AKI. In this review, we outline the recent progress on each of these fronts.

show abstract

“…These patients participated in pharmacological intervention trials performed by our research group in 2006–2014 [14–17]. The inclusion criteria were: (a) age >18 years, (b) elective cardiac surgery with cardiopulmonary bypass, (c) preoperative left ventricular ejection fraction ≥ 40%, and (d) preoperative serum creatinine within normal range.…”

Section: Methodsmentioning

confidence: 99%

“…The catheter was placed in the central portion of the renal vein, the position being confirmed by venography using ultra-low doses of iohexol, 5–15 mg I kg − 1 (Omnipaque 300 mg I ml − 1; GE Healthcare, Stockholm, Sweden). Renal blood flow (RBF) was measured in triplicate by the continuous retrograde thermodilution technique [14, 17, 19, 20]. After the collection of blood and urine blanks, an intravenous priming dose of 51 Cr-EDTA (GE Healthcare, Amersham, UK) was given, followed by an infusion at a constant rate, individualized to body surface area and to preoperative serum creatinine.…”

Section: Methodsmentioning

confidence: 99%

Renal function and oxygenation are impaired early after liver transplantation despite hyperdynamic systemic circulation

et al. 2017

View full text Add to dashboard Cite

BackgroundAcute kidney injury (AKI) occurs frequently after liver transplantation and is associated with the development of chronic kidney disease and increased mortality. There is a lack of data on renal blood flow (RBF), oxygen consumption, glomerular filtration rate (GFR) and renal oxygenation, i.e. the renal oxygen supply/demand relationship, early after liver transplantation. Increased insight into the renal pathophysiology after liver transplantation is needed to improve the prevention and treatment of postoperative AKI. We have therefore studied renal hemodynamics, function and oxygenation early after liver transplantation in humans.MethodsSystemic hemodynamic and renal variables were measured during two 30-min periods in liver transplant recipients (n = 12) and post-cardiac surgery patients (controls, n = 73). RBF and GFR were measured by the renal vein retrograde thermodilution technique and by renal extraction of Cr-EDTA (= filtration fraction), respectively. Renal oxygenation was estimated from the renal oxygen extraction.ResultsIn the liver transplant group, GFR decreased by 40% (p < 0.05), compared to the preoperative value. Cardiac index and systemic vascular resistance index were 65% higher (p < 0.001) and 36% lower (p < 0.001), respectively, in the liver transplant recipients compared to the control group. GFR was 27% (p < 0.05) and filtration fraction 40% (p < 0.01) lower in the liver transplant group. Renal vascular resistance was 15% lower (p < 0.05) and RBF was 18% higher (p < 0.05) in liver transplant recipients, but the ratio between RBF and cardiac index was 27% lower (p < 0.001) among the liver-transplanted patients compared to the control group. Renal oxygen consumption and extraction were both higher in the liver transplants, 44% (p < 0.01) and 24% (p < 0.05) respectively.ConclusionsDespite the hyperdynamic systemic circulation and renal vasodilation, there is a severe decline in renal function directly after liver transplantation. This decline is accompanied by an impaired renal oxygenation, as the pronounced elevation of renal oxygen consumption is not met by a proportional increase in renal oxygen delivery. This information may provide new insights into renal pathophysiology as a basis for future strategies to prevent/treat AKI after liver transplantation.Trial registrationClinicalTrials.gov, NCT02455115. Registered on 23 April 2015.

show abstract

Effects of acute plasma volume expansion on renal perfusion, filtration, and oxygenation after cardiac surgery: a randomized study on crystalloid vs colloid

Abstract: NCT01729364.

Cited by 35 publications

References 29 publications

Renal effects of norepinephrine‐induced variations in mean arterial pressure after liver transplantation: A randomized cross‐over trial

Renal effects of norepinephrine‐induced variations in mean arterial pressure after liver transplantation: A randomized cross‐over trial

Renal haemodynamics and oxygenation during and after cardiac surgery and cardiopulmonary bypass

Renal function and oxygenation are impaired early after liver transplantation despite hyperdynamic systemic circulation

Contact Info

Product

Resources

About