The effect of sodium nitroprusside infusion on renal function during reperfusion period in patients undergoing coronary artery bypass grafting: a prospective randomized clinical trial

Kaya, Kaan; Oğuz, Mehmet; Akar, Ahmet; Durdu, Serkan; Aslan, Alp; Erturk, Sebnem; Taşöz, Refik; Özyurda, Ümit

doi:10.1016/j.ejcts.2006.11.015

Cited by 40 publications

(19 citation statements)

References 25 publications

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“…Massoudy et al 21 reported that administration of SNP (as an NO donor) for just the first 20 minutes of reperfusion to patients undergoing CABG led to a reduction of the acute inflammatory response, especially a reduction in levels of interleukin-6 and interleukin-8. Kaya et al 22 showed that SNP could inhibit the deleterious effects of cardiopulmonary bypass on the kidney. Cakir et al 23 described an antiinflammatory action of SNP in lung tissue during total cardiopulmonary bypass.…”

Section: Discussionmentioning

confidence: 99%

Does Sodium Nitroprusside Decrease the Incidence of Atrial Fibrillation After Myocardial Revascularization?

Cavolli¹,

Kaya²,

Aslan³

et al. 2008

Circulation

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Background-Atrial fibrillation (AF) often occurs after coronary artery bypass grafting and can result in increased morbidity and mortality. In the present pilot study, our aim was to investigate whether sodium nitroprusside (SNP), as a nitric oxide donor, can reduce the frequency of post-coronary artery bypass grafting AF. Methods and Results-To investigate the effectiveness of SNP in the prophylaxis of AF, we conducted a prospective, randomized, placebo-controlled clinical study on 100 consecutive patients in whom we performed elective and initial CABG operations. A control group of 50 patients were treated with placebo (dextrose 5% in water), whereas the SNP group (nϭ50 patients) was treated with SNP (0.5 g · kg Ϫ1 · min Ϫ1 ) during the rewarming period. High-sensitivity C-reactive protein levels were measured before surgery and 5 days postoperatively. All patients were monitored postoperatively with telemetry. Baseline characteristics were similar in both treatment groups. AF occurred in 12% of the SNP group and 27% of the control group. The occurrence of AF was significantly lower in the SNP group (Pϭ0.005). The duration of AF in the SNP group was significantly shorter than that in the control group (5.33Ϯ1.86 and 7.55Ϯ1.94 hours, respectively; Pϭ0.023). C-reactive protein levels were higher postoperatively in the control group than in the SNP group (PϽ0.05). Postoperative AF significantly prolonged postoperative hospital stay (PϽ0.05). Conclusions-The

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Section: Discussionmentioning

confidence: 99%

Does Sodium Nitroprusside Decrease the Incidence of Atrial Fibrillation After Myocardial Revascularization?

Cavolli¹,

Kaya²,

Aslan³

et al. 2008

Circulation

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“…Nifedipine, α 2 -adrenergic agonists, prostaglandin E 1 , fenoldopam, diltiazem, pentoxifylline, phosphodiesterase III inhibitor, β-blocker, N -acetylcysteine, natriuretic peptides, and sodium nitroprusside are some examples of these experimental interventions [16, 17,19,20,21,25,26,27,28,29,30,31,32,33]. However, discordant results among studies have result from the differences in the populations being studied, the intervention applied, and the outcome measured.…”

Section: Discussionmentioning

confidence: 99%

“…Two recent studies using N -acetylcysteine to prevent AKI in cardiac surgery have shown negative results [16, 17]. Natriuretic peptides or sodium nitroprusside may play preventive roles in AKI when applied before surgery [18,19,20,21]. However, there are no proven interventions to prevent AKI after cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Prevention of Acute Kidney Injury by Erythropoietin in Patients Undergoing Coronary Artery Bypass Grafting: A Pilot Study

Song

Lee²,

You³

et al. 2009

Am J Nephrol

127

137

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Background/Aims: Depending on the specific definition, acute kidney injury (AKI) occurs in 7–40% of patients undergoing cardiac surgery. Even small changes in serum creatinine (SCr) levels are associated with increased mortality after cardiac surgery. However, there are no current methods for preventing AKI after cardiac surgery. Erythropoietin (EPO) has been shown to elicit tissue-protective effects in various experimental models. In this pilot trial, we evaluated the effectiveness of EPO in the prevention of AKI after coronary artery bypass grafting (CABG). Methods: 71 patients scheduled for elective CABG randomly received either 300 U/kg of EPO or saline intravenously before surgery. AKI was defined as a 50% increase in SCr levels over baseline within the first 5 postoperative days. Estimated glomerular filtration rate (eGFR) was calculated from the Cockcroft-Gault equation. Results: Of 71 patients, 13 developed postoperative AKI: 3 of the 36 patients in the EPO group (8%) and 10 of the 35 patients in the placebo group (29%; p = 0.035). The increase in postoperative SCr concentration and the decline in postoperative eGFR were significantly lower in the EPO group than in the placebo group. Conclusions: In our small, pilot trial, prophylactic administration of EPO prevents AKI and improves postoperative renal function. These data are preliminary and require confirmation in a larger clinical trial.

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“…[1][2][3] The incidence of acute renal failure (ARF) requiring renal replacement therapy is 3.53% in a review of Society of Thoracic Surgeons (STS) database. 4) To date, a number of different strategies, including new pharmacologic agents, off-pump and cardiopulmonary bypass techniques have been used to avoid it.…”

Section: Introductionmentioning

confidence: 99%

“…4) To date, a number of different strategies, including new pharmacologic agents, off-pump and cardiopulmonary bypass techniques have been used to avoid it. Considering pharmacologic agents, a few medications have been used by now such as prostacyclin, nitroprussid, levosimendan, dexamethasone and n-acetylcysteine, 2,[5][6][7][8][9][10] but none of them proves the excellent result for it. In this study, we sought to determine the renal effect of iloprost during the reperfusion period in patients undergoing CABG.…”

Section: Introductionmentioning

confidence: 99%

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

Darçin

Zor

Şahin

et al. 2013

ATCS

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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.

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The effect of sodium nitroprusside infusion on renal function during reperfusion period in patients undergoing coronary artery bypass grafting: a prospective randomized clinical trial

Abstract: SNP administration during rewarming period of non-pulsatile CPB in patients undergoing CABG surgery is associated with improved renal function compared with conventional medical treatment providing adequate preload and mean arterial pressures.

Cited by 40 publications

References 25 publications

Does Sodium Nitroprusside Decrease the Incidence of Atrial Fibrillation After Myocardial Revascularization?

Does Sodium Nitroprusside Decrease the Incidence of Atrial Fibrillation After Myocardial Revascularization?

Prevention of Acute Kidney Injury by Erythropoietin in Patients Undergoing Coronary Artery Bypass Grafting: A Pilot Study

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

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