Nitric Oxide Decreases Acute Kidney Injury and Stage 3 Chronic Kidney Disease after Cardiac Surgery

Lei, Chong; Berra, Lorenzo; Rezoagli, Emanuele; Yu, Binglan; Dong, Hailong; Yu, Shuang; Hou, Lihong; Chen, Min; Chen, Wensheng; Wang, Hongbing; Zheng, Qijun; Shen, Jie; Jin, Zhenxiao; Chen, Tao; Zhao, Ruiyang; Christie, Emily; Sabbisetti, Venkata; Nordio, Francesco; Bonventre, Joseph V.; Xiong, Lize; Zapol, Warren M.

doi:10.1164/rccm.201710-2150oc

Cited by 119 publications

(132 citation statements)

References 49 publications

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“…Some ARDS studies indicated that iNO can adversely affect renal function [9]; however, the mechanism is unclear. A recent study showed that the administration of 80 ppm NO gas into the extracorporeal circulation in conjunction with postoperative iNO treatment significantly reduced the occurrence of renal dysfunction after valve replacement surgery [27]. Recently, Hyun-Su et al reported that iNO did not worsen renal function after lung transplantation; nearly half of the patients in that study were administered extracorporeal membrane oxygenation [28].…”

Section: Discussionmentioning

confidence: 99%

Effects of inhaled nitric oxide for postoperative hypoxemia in acute type A aortic dissection: a retrospective observational study

Zhang

Liu

Meng

et al. 2020

J Cardiothorac Surg

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Background: Postoperative hypoxemia in acute type A aortic dissection (AADA) is a common complication and is associated with negative outcomes. This study aimed to analyze the efficacy of low-dose (5-10 ppm) inhaled nitric oxide (iNO) in the management of hypoxemia after AADA surgery. Methods: In this retrospective observational study, Medical records of patients who underwent AADA surgery at two institutions between January 2015 and January 2018 were collected. Patients with postoperative hypoxemia were classified as iNO and control groups. Clinical characteristics and outcomes were compared using a propensity score-matched (PSM) analysis. Results: Among 436 patients who underwent surgical repair, 187 (42.9%) had hypoxemia and 43 were treated with low-dose iNO. After PSM, patients were included in the iNO treatment (n = 40) and PSM control (n = 94) groups in a 1:3 ratio. iNO ameliorated hypoxemia at 6, 24, 48, and 72 h after initiation, and shortened the durations of ventilator support (39.0 h (31.3-47.8) vs. 69.0 h (47.8-110.3), p < 0.001) and ICU stay (122.0 h (80.8-155.0) vs 179.5 h (114.0-258.0), p < 0.001).There were no significant between-group differences in mortality, complications, or length of hospital stay. Conclusions: In this study, we found that low-dose iNO improved oxygenation in patients with hypoxemia after AADA surgery and shortened the durations of mechanical ventilation and ICU stay. No significant side effects or increase in postoperative mortality or morbidities were observed with iNO treatment. These findings warrant a randomized multicenter controlled trial to assess the exact efficiency of iNO for hypoxemia after AADA.

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Section: Discussionmentioning

confidence: 99%

Effects of inhaled nitric oxide for postoperative hypoxemia in acute type A aortic dissection: a retrospective observational study

Zhang

Liu

Meng

et al. 2020

J Cardiothorac Surg

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“…The diagnosis of AKI is based on two functional markers, an increase of serum creatinine and a reduction of urinary excretion. Predictors of perioperative AKI in patients undergoing heart surgery include preoperative creatinine level, endstage renal disease, 2-2 phenotype of haptoglobin, advanced age, diabetes mellitus, congestive heart failure, generalized atherosclerosis, cardiovascular collapse, nitric oxide, cyanotic heart disease, duration of surgery and elevated postoperative lactate level [4][5][6][7][8][9]. In patients with severe AKI, oliguria and fluid accumulation, renal replacement therapy is the basic method of treatment [10].…”

Section: Introductionmentioning

confidence: 99%

Anisocytosis predicts postoperative renal replacement therapy in patients undergoing heart valve surgery

et al. 2020

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Background: Acute kidney injury (AKI) is one of the serious postoperative complications in patients undergoing heart valve surgery. The aim of the present study was to identify selected biomarkers to predict AKI requiring renal replacement. Methods: A prospective study was conducted on a group of 751 patients undergoing heart valve surgery. The data on risk factors, preoperative complete blood count, course of operations and postoperative period was assessed. The primary endpoint at the 30-day follow-up was postoperative AKI requiring renal replacement therapy. The secondary end-point was death from all causes in patients with postoperative AKI requiring renal replacement. Results: The primary endpoint occurred in 46 patients. At multivariate analysis: age, red cell distribution width (RDW) and C-reactive protein remained independent predictors of the primary endpoint. Hemoglobin and RDW were associated with an increased risk of death. Conclusions: Elevated RDW is associated with a higher risk of postoperative AKI and death in patients with AKI. (Cardiol J XXXX; XX, X: xx-xx)

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“…Thus, the main target of iNO is lung and pulmonary circulation. In addition, iNO effects on remote organs, such as the kidney [47], liver [48,49], heart [50], and muscle [51], have been investigated, with iNO shown to ameliorate inflammation and ischemia-reperfusion injury.…”

Section: Clinical Effects Of Inomentioning

confidence: 99%

Endogenous and Inhaled Nitric Oxide for the Treatment of Pulmonary Hypertension

Maruyama¹,

Maruyama²,

Sawada³

2020

Basic and Clinical Understanding of Microcirculation

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Since the discovery of nitric oxide (NO) as a physiological substance produced in the endothelium, the impairment of endothelial NO production and reactivity of the pulmonary vasculature to NO have been described in animal models and patients with pulmonary hypertension (PH). The NO synthase-NO-cyclic guanosine monophosphate (cGMP) pathway is impaired in pulmonary arterial hypertension (PAH), pulmonary veno-occlusive disease (PVOD), pulmonary capillary hemangiomatosis (PCH), chronic obstructive pulmonary disease (COPD), and idiopathic pulmonary fibrosis (IPF). Pioneering clinicians conceived that NO can be administered to the lung by inhalation and used this strategy to treat PH in humans and acute hypoxic PH in animal models. Inhaled NO (iNO) selectively decreases pulmonary arterial pressure with no changes in systemic arterial pressure. When iNO diffuses into the blood, it is converted to NO 3 − , thereby losing its vasodilatory effects. NO might then be recycled in hypoxic remote organs, where NO 3 − and NO 2 − are reduced to NO. In the present chapter, the metabolic fate of iNO, based on previous air pollution research in Japan, is discussed. Then, we describe recent clinical applications of iNO in pediatric patients with various diseases, including bronchopulmonary dysplasia (BPD), persistent PH of neonates, and congenital diaphragmatic hernia (CDH). We also summarize the role of iNO in the catheterization lab, including acute vasoreactivity testing to assess prognosis, indications for specific PH therapy, and operability of congenital heart disease.

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Nitric Oxide Decreases Acute Kidney Injury and Stage 3 Chronic Kidney Disease after Cardiac Surgery

Cited by 119 publications

References 49 publications

Effects of inhaled nitric oxide for postoperative hypoxemia in acute type A aortic dissection: a retrospective observational study

Effects of inhaled nitric oxide for postoperative hypoxemia in acute type A aortic dissection: a retrospective observational study

Anisocytosis predicts postoperative renal replacement therapy in patients undergoing heart valve surgery

Endogenous and Inhaled Nitric Oxide for the Treatment of Pulmonary Hypertension

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