Leukodepletion Improves Renal Function in Patients with Renal Dysfunction Undergoing On-Pump Coronary Bypass Surgery: A Prospective Randomized Study

Bolcal, Cengiz; Akay, Hatice; Bingöl, Hakan; Doğancı, Suat; Yıldırım, Vedat; Yenicesu, Müjdat; Demirkılıç, Ufuk; Tatar, Harun

doi:10.1055/s-2006-924571

Cited by 26 publications

(15 citation statements)

References 6 publications

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“…Similarly, the use of extracorporeal techniques to remove myoglobin will require membranes with a high cutoff [266], possibly used in series for a minimal duration of 6 h, which is not readily available [267][268][269][270][271][272][273]. Four studies have evaluated leukodepletion during cardiopulmonary bypass [274][275][276][277], with three suggesting a beneficial effect on renal function [274][275][276].…”

Section: Clinical Studiesmentioning

confidence: 99%

Prevention of acute kidney injury and protection of renal function in the intensive care unit

et al. 2009

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Background: Acute renal failure on the intensive care unit is associated with significant mortality and morbidity. Objectives: To determine recommendations for the prevention of acute kidney injury (AKI), focusing on the role of potential preventative maneuvers including volume expansion, diuretics, use of inotropes, vasopressors/vasodilators, hormonal interventions, nutrition, and extracorporeal techniques. Method: A systematic search of the literature was performed for studies using these potential protective agents in adult patients at risk for acute renal failure/kidney injury between 1966 and 2009. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, and use of potentially nephrotoxic drugs and radiocontrast media. Where possible the following endpoints were extracted: creatinine clearance, glomerular filtration rate, increase in serum creatinine, urine output, and markers of tubular injury. Clinical endpoints included the need for renal replacement therapy, length of stay, and mortality. Studies are graded according to the international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) group system Conclusions and recommendations: Several measures are recommended, though none carries grade 1A. We recommend prompt resuscitation of the circulation with special attention to providing adequate hydration whilst avoiding high-molecular-weight hydroxy-ethyl starch (HES) preparations, maintaining adequate blood Intensive Care Med (2010) 36:392-411 DOI 10.1007/s00134-009-1678 EXPERT PANEL pressure using vasopressors in vasodilatory shock. We suggest using vasopressors in vasodilatory hypotension, specific vasodilators under strict hemodynamic control, sodium bicarbonate for emergency procedures administering contrast media, and periprocedural hemofiltration in severe chronic renal insufficiency undergoing coronary intervention.

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Section: Clinical Studiesmentioning

confidence: 99%

Prevention of acute kidney injury and protection of renal function in the intensive care unit

et al. 2009

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“…1). A total of 70 studies (5,554 patients) met eligibility criteria [17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86] (table 1). …”

Section: Resultsmentioning

confidence: 99%

“…The incidence of acute renal replacement therapy was provided in 21 studies comprising 2,172 patients [18,25,27,28,32,33,34,40,45,52,55,56,60,61,67,69,71,75,77,81,82]. Predefined criteria for acute renal replacement therapy initiation were provided in 7 of these studies and were not uniform across studies [25,27,40,55,56,77,81].…”

Section: Resultsmentioning

confidence: 99%

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Prevention and Treatment of Acute Kidney Injury in Patients Undergoing Cardiac Surgery: A Systematic Review

et al. 2010

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Background: Acute kidney injury (AKI) is common in patients undergoing cardiac surgery and is associated with a high rate of death, long-term sequelae and healthcare costs. We conducted a systematic review of randomized controlled trials for strategies to prevent or treat AKI in cardiac surgery. Methods: We screened Medline, Scopus, Cochrane Renal Library, and Google Scholar for randomized controlled trails in cardiac surgery for prevention or treatment of AKI in adults. Results: We identified 70 studies that contained a total of 5,554 participants published until November 2008. Most studies were small in sample size, were single-center, focused on preventive strategies, and displayed wide variation in AKI definitions. Only 26% were assessed to be of high quality according to the Jadad criteria. The types of strategies with possible protective efficacy were dopaminergic agents, vasodilators, anti-inflammatory agents, and pump/perfusion strategies. When analyzed separately, dopamine and N-acetylcysteine did not reduce the risk for AKI. Conclusions: This summary of all the literature on prevention and treatment strategies for AKI in cardiac surgery highlights the need for better information. The results advocate large, good-quality, multicenter studies to determine whether promising interventions reliably reduce rates of acute renal replacement therapy and mortality in the cardiac surgery setting.

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“…The antioxidant N-acetylcysteine was found to have no effect in preventing ARF in cardiac patients,35 or in reducing the rate of renal failure in patients undergoing heart and/or aortic surgery 36–38. The renal function of on-pump CABG patients was improved by leukodepletion, which prevented tubule destruction,39 and infusion of sodium nitroprusside resulted in improved renal function in cardiac patients 40. As hydration prior to surgery has been found to prevent renal damage,41 our patients were infused with 1–2 L of normal saline to prevent confounding the effects of dehydration with those of allopurinol and vitamin E. Calcium channel blockers, such as diltiazem42 and verapamil,43 have been shown to increase urine output and to maintain tubular integrity after cardiac surgery, without significantly affecting the GFR.…”

Section: Discussionmentioning

confidence: 99%

Effects of allopurinol and vitamin E on renal function in patients with cardiac coronary artery bypass grafts

Nouri-Majalan

Ardakani²,

Forouzannia³

et al. 2009

VHRM

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Background:Acute renal failure is a common complication of cardiac surgery, with oxidants found to play an important role in renal injury. We therefore assessed whether the supplemental antioxidant vitamin E and the inhibitor of xanthine oxidase allopurinol could prevent renal dysfunction after coronary artery bypass graft (CABG) surgery.Methods:Of 60 patients with glomerular filtration rate (GFR) < 60 mL/min scheduled to undergo CABG surgery, 30 were randomized to treatment with vitamin E and allopurinol for 3–5 days before surgery and 30 to no treatment. Serum creatinine levels and potassium and creatinine clearances were measured preoperatively and daily until day 5 after surgery.Results:The patients consisted of 31 males and 29 females, with a mean age of 63 ± 9 years. After surgery, there were no significant differences in mean serum creatinine (1.2 ± 0.33 vs 1.2 ± 0.4 mg/dL; p = 0.43) concentrations, or creatinine clearance (52 ± 12.8 vs 52 ± 12.8 mL/min; p = 0.9). The frequency of acute renal failure did not differ in treatment group compared with control (16% vs 13%; p = 0.5). Length of stay in the intensive care unit (ICU) was significantly longer in the control than in the treated group (3.9 ± 1.5 vs 2.6 ± 0.7 days; p < 0.001).Conclusion:Prophylactic treatment with vitamin E and allopurinol had no renoprotective effects in patients with pre-existing renal failure undergoing CABG surgery. Treatment with these agents, however, reduces the duration of ICU stay.

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Leukodepletion Improves Renal Function in Patients with Renal Dysfunction Undergoing On-Pump Coronary Bypass Surgery: A Prospective Randomized Study

Abstract: Patients with renal dysfunction undergoing on-pump CABG surgery seem to benefit from leukodepletion as a measure to prevent tubular damage and renal impairment compared with a control group.

Cited by 26 publications

References 6 publications

Prevention of acute kidney injury and protection of renal function in the intensive care unit

Prevention of acute kidney injury and protection of renal function in the intensive care unit

Prevention and Treatment of Acute Kidney Injury in Patients Undergoing Cardiac Surgery: A Systematic Review

Effects of allopurinol and vitamin E on renal function in patients with cardiac coronary artery bypass grafts

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Leukodepletion Improves Renal Function in Patients with Renal Dysfunction Undergoing On-Pump Coronary Bypass Surgery: A Prospective Randomized Study

Abstract: Patients with renal dysfunction undergoing on-pump CABG surgery seem to benefit from leukodepletion as a measure to prevent tubular damage and renal impairment compared with a control group.

Cited by 26 publications

References 6 publications

Prevention of acute kidney injury and protection of renal function in the intensive care unit

Prevention of acute kidney injury and protection of renal function in the intensive care unit

Prevention and Treatment of Acute Kidney Injury in Patients Undergoing Cardiac Surgery: A Systematic Review

Effects of allopurinol and vitamin&nbsp;E on renal function in patients with cardiac coronary artery bypass grafts

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Effects of allopurinol and vitamin E on renal function in patients with cardiac coronary artery bypass grafts