RETRACTED ARTICLE: Influence of two different volume replacement regimens on renal function in elderly patients undergoing cardiac surgery: comparison of a new starch preparation with gelatin

Boldt, Joachim; Brenner, Thorsten; Lehmann, Andreas; Lang, Johannes; Kumle, Bernhard; Werling, Christiane

doi:10.1007/s00134-003-1702-6

Cited by 96 publications

(45 citation statements)

References 30 publications

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“…Some reports have shown that HES has no adverse infl uence on renal function in surgical patients [19,20], while other reports have shown that HES may impair renal function in surgical patients [21,22]. A recent review suggested that HES may have adverse effects on renal function, regardless of its molecular weight, DS, or C2/C6 ratio [23].…”

Section: Discussionmentioning

confidence: 96%

Influence of low-molecular-weight hydroxyethyl starch on microvascular permeability in patients undergoing abdominal surgery: comparison with crystalloid

Ando¹,

Terao²,

Fukusaki³

et al. 2008

J Anesth

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Section: Discussionmentioning

confidence: 96%

Influence of low-molecular-weight hydroxyethyl starch on microvascular permeability in patients undergoing abdominal surgery: comparison with crystalloid

Ando¹,

Terao²,

Fukusaki³

et al. 2008

J Anesth

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“…As colistin is extensively reabsorbed by renal tubular cells and causes apoptosis (18,50), urinary NGAL and NAG excretion was monitored in the present study. Under normal conditions, urinary excretion of NGAL and NAG is low, but the excretion rises sharply from the respective basal levels in response to kidney injury to reach diagnostic levels within a very short time, as much as 24 h or more before any significant rise in serum creatinine (51)(52)(53)(54)(55)(56)(57). In the current study, the rates of urinary excretion of NGAL and NAG on day 3 or 5 of colistin treatment and at the end of treatment, in all patients as well as those with AKI as defined by the RIFLE system, were significantly higher than the respective baseline values in both the colistin and the colistin-ascorbic acid groups.…”

Section: Discussionmentioning

confidence: 97%

Preliminary Clinical Study of the Effect of Ascorbic Acid on Colistin-Associated Nephrotoxicity

Sirijatuphat

Limmahakhun

Sirivatanauksorn

et al. 2015

Antimicrob Agents Chemother

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c Nephrotoxicity is a dose-limiting factor of colistin, a last-line therapy for multidrug-resistant Gram-negative bacterial infections. An earlier animal study revealed a protective effect of ascorbic acid against colistin-induced nephrotoxicity. The present randomized controlled study was conducted in 28 patients and aimed to investigate the potential nephroprotective effect of intravenous ascorbic acid (2 g every 12 h) against colistin-associated nephrotoxicity in patients requiring intravenous colistin. Thirteen patients received colistin plus ascorbic acid, whereas 15 received colistin alone. Nephrotoxicity was defined by the RIFLE classification system. Additionally, urinary neutrophil gelatinase-associated lipocalin (NGAL) and N-acetyl-beta-D-glucosaminidase (NAG) were measured as markers of renal damage, and plasma colistin concentrations were quantified. The baseline characteristics, clinical features, and concomitant treatments of the patients in the two groups were comparable. The incidences of nephrotoxicity were 53.8% (7/13) and 60.0% (9/15) in the colistin-ascorbic acid group and the colistin group, respectively (P ‫؍‬ 0.956; relative risk [RR], 0.9; 95% confidence interval, 0.47 to 1.72). In both groups, the urinary excretion rates of NGAL and NAG on day 3 or 5 of colistin treatment and at the end of colistin treatment were significantly higher than those at the respective baselines (P < 0.05). However, the urinary excretion rates of these biomarkers at the various times during colistin treatment did not differ significantly between the groups (P > 0.05). The plasma colistin concentrations in the two groups were not significantly different (P > 0.28). The clinical and microbiological outcomes and mortality of the patients in the two groups were not significantly different. This preliminary study suggests that ascorbic acid does not offer a nephroprotective effect for patients receiving intravenous colistin. (This study has been registered at ClinicalTrials.gov under registration no. NCT01501968.) I nfections caused by carbapenem-resistant Gram-negative bacteria, such as Acinetobacter baumannii, have become a serious problem globally, including in Thailand (1-3). Colistin (i.e., polymyxin E) and polymyxin B have been reintroduced over the past decade for therapy of multidrug-resistant (MDR) Gram-negative bacterial infections, especially those caused by carbapenem-resistant Gram-negative pathogens (4). Colistin is administered parenterally as colistimethate sodium (CMS), an inactive prodrug that is converted to colistin, the entity that possesses both antibacterial activity and the potential to cause toxicity (5, 6). The efficacy of colistin for treatment of infections by MDR Gram-negative bacteria is modest, and nephrotoxicity is the major dose-limiting factor in the clinical use of colistin (7, 8). The incidence of colistinassociated nephrotoxicity ranges from approximately 10% to 55%, and it appears to be related to the total dose of CMS, the duration of therapy, and the plasma colistin concentrat...

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“…However, another study found that the rise in urinary NAG is extremely sensitive to renal tubular injury and increases also in patients who do not develop clinical AKI after surgery [32,33]. Similarly, Blaikley et al [34] found RBP to rise significantly 3 h after cardiac surgery in a small study of 7 patients, but did not calculate its predictive value.…”

Section: Discussionmentioning

confidence: 99%

Clinical Usefulness of Novel Biomarkers for the Detection of Acute Kidney Injury following Elective Cardiac Surgery

et al. 2010

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Background/Aims: Acute kidney injury (AKI) is common following cardiac surgery and predicts a poor outcome. However, the early detection of AKI has proved elusive and most cases are diagnosed only following a significant rise in serum creatinine (SCr). We compared a panel of early biomarkers of AKI for the detection of AKI in patients undergoing heart surgery. This study included serum cystatin C (CyC) and urinary levels of neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), retinol-binding protein (RBP) and N-acetyl-β-D-glucosaminidase (NAG). Methods: We retrospectively identified 15 patients undergoing open cardiac surgery who developed AKI within 72 h postoperatively. For these, we identified 15 matched controls also having undergone surgery but without AKI. Serial serum and urine samples had prospectively been postoperatively obtained from all patients at 0, 2, 4, 6, 10, 24, 48 and 72 h after admission to the intensive care unit. AKI was defined as a >50% increase in SCr. CyC was measured by nephelometry, while NGAL, IL-18, and RBP were measured by ELISA and NAG was measured by spectrophotometry. The urinary biomarkers were normalized to urinary creatinine (UCr) concentration. Each marker was assessed at each time point for its predictive value using receiver operating characteristic curves to predict AKI. Results: Following the exclusion of 1 case due to a urinary tract infection, the final cohort consisted of 29 patients aged 62.9 ± 13.7 years with baseline SCr of 73.2 ± 11.9 µmol/l. While there were no differences in the demographics between cases and controls, the aortic clamp time was predictably higher in AKI cases than in controls (60.6 ± 13.9 vs. 43.0 ± 9.2 min, p < 0.05). Each biomarker differed significantly between cases and controls for at least one time point. The optimal area under the curve (AUC) was for CyC at 10 h (sensitivity 0.71, specificity 0.92, cutoff 1.31 mg/l), NGAL at 0 h (sensitivity 0.84, specificity 0.80, cutoff 49.15 µg/g UCr), IL-18 at 2 h (sensitivity 0.85, specificity 0.73, cutoff 285.65 ng/g UCr), RBP at 0 h (sensitivity 0.75, specificity 0.67, cutoff 2,934.65 µg/g UCr) and NAG at 4 h (sensitivity 0.86, specificity 0.67, cutoff 37.05 U/mg UCr). Using a combination of all 5 biomarkers analyzed at the optimal time point as above, we were able to obtain an AUC of 0.98 (0.93–1.02, p < 0.001) in this limited sample. Conclusion: The use of serum and urinary biomarkers for the prediction of AKI in patients undergoing cardiac surgery is highly dependent on the sampling time. Of the evaluated markers urinary NGAL had the best predictive profile. The previously unstudied marker of urinary RBP showed similar predictive power as more established markers. By combining all 5 studied biomarkers we were able to predict significantly more cases, suggesting that the use of more than one marker may be beneficial clinically.

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RETRACTED ARTICLE: Influence of two different volume replacement regimens on renal function in elderly patients undergoing cardiac surgery: comparison of a new starch preparation with gelatin

Abstract: Sensitive markers of kidney dysfunction increased in our elderly patients indicating moderate alterations in kidney integrity during cardiac surgery. The two volume replacement regimens did not differ with regard to kidney integrity in elderly patients undergoing cardiac surgery.

Cited by 96 publications

References 30 publications

Influence of low-molecular-weight hydroxyethyl starch on microvascular permeability in patients undergoing abdominal surgery: comparison with crystalloid

Influence of low-molecular-weight hydroxyethyl starch on microvascular permeability in patients undergoing abdominal surgery: comparison with crystalloid

Preliminary Clinical Study of the Effect of Ascorbic Acid on Colistin-Associated Nephrotoxicity

Clinical Usefulness of Novel Biomarkers for the Detection of Acute Kidney Injury following Elective Cardiac Surgery

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