scholarly journals Effect of Ascorbic Acid on Postoperative Acute Kidney Injury in Coronary Artery Bypass Graft Patients: A Pilot Study

2017 ◽  
Vol 20 (5) ◽  
pp. 214 ◽  
Author(s):  
Miha Antonic
Keyword(s):  
Acute Kidney Injury ◽  
Ascorbic Acid ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
Serum Creatinine ◽  
Renal Injury ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Acid Group ◽  
Postoperative Serum

Background: Even minor postoperative reductions in renal function influence the outcome of cardiac surgery. The mechanisms of postoperative renal injury in cardiac surgery are multifactorial and include ischemia-reperfusion injury. The study investigates the effect of the antioxidant ascorbic acid on the postoperative acute kidney injury after elective CABG surgery.Methods: A prospective randomized single-center trial was conducted in on-pump coronary artery bypass patients. The patients in the ascorbic acid group received 2 grams of ascorbic acid 24 hours and 2 hours preoperatively and 1 gram twice daily five days after the surgery.  Postoperatively, the subjects were monitored for renal dysfunction and other complications.Results: 100 patients were included, with 50 patients in each study group. The groups were well matched for baseline demographics, preoperative medications, comorbidities, and had similar intraoperative characteristics. The incidence of postoperative acute kidney injury in the ascorbic acid group was 16% and 14% in the control group (P = .779). The groups also did not differ in peak postoperative serum creatinine (83 [33] µmol/L versus 83 [39] µmol/L; P = .434), the lowest postoperative creatinine clearance (96.40 ± 35.78 mL/min versus 90.89 ± 36.18 mL/min; P = .766), and time from surgery to the onset of peak postoperative serum creatinine (1.64 ± 1.34 days versus 1.92 ± 1.54 days; P = .393). There was no dialysis required in any patient. Conclusion: The results of this study did not demonstrate a significant protective effect of ascorbic acid on the incidence of postoperative acute renal injury in elective on-pump CABG patients.

scholarly journals Role of Serum creatinine in forecasting the outcome after cardiac surgery beyond acute kidney injury-A Cross sectional Study

2021 ◽  
pp. 105-108
Author(s):  
DIVYA DHARSHINI B ◽  
SMITA PADHY ◽  
GIRIJAVANI D S S ◽  
PAYALA VIJAYA LAKSHMI
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Serum Creatinine ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Critical Determinant ◽  
Cross Sectional ◽  
Significance Level

Objectives: Acute kidney damage (Acute kidney injury [AKI]) is defined by elevations in serum creatinine levels that occur after surgery. In cardiac surgery, creatinine is a critical determinant. This study highlights the detection of serum creatinine as an early diagnostic and predictive marker of AKI following coronary artery bypass grafting (CABG) and to estimate the serum creatinine concentrations before and at 24 and 48 h after CABG. Methods: It is a single center, Cross-sectional study. Patients from Cardiothoracic and Vascular surgery undergoing CABG in Sri Ramachandra Medical College and Research Institute were included in the study. A total of 80 cases were included in the study. The method used for measurement of serum creatinine is by modification of kinetic Jaffe reaction. Data were analyzed using Stata/SE version 16.0 and represented in terms of means, standard deviation at 95% confidence level and t’ test was performed as statistical analysis and p<0.05 indicates significance. Sigma plot software version 10.0 was used to draw the standard error mean graphs. Results: The serum creatinine values at 24 h after the surgery was statistically higher than the preoperative values at 5% significance level (p=0.04). The serum creatinine values 48 h after the surgery was also statistically higher than the preoperative values at 1% significance level (p=0.001). The serum creatinine values 48 h after surgery are highly significant (p=0.001) when compared to the serum creatinine values 24 h after surgery. Conclusion: Before an increase in serum creatinine level is detected, over 50% of renal function must be lost. It was concluded that serum creatinine is an inadequate and delayed marker of AKI.

Cyclosporine before Coronary Artery Bypass Grafting Does Not Prevent Postoperative Decreases in Renal Function

2018 ◽  
Vol 128 (4) ◽  
pp. 710-717 ◽  
Author(s):  
Per Ederoth ◽  
Alain Dardashti ◽  
Edgars Grins ◽  
Björn Brondén ◽  
Carsten Metzsch ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Extracorporeal Circulation ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Bypass Grafting

Abstract Background Acute kidney injury is a common complication after cardiac surgery, leading to increased morbidity and mortality. One suggested cause for acute kidney injury is extracorporeal circulation–induced ischemia–reperfusion injury. In animal studies, cyclosporine has been shown to reduce ischemia–reperfusion injury in the kidneys. We hypothesized that administering cyclosporine before extracorporeal circulation could protect the kidneys in patients undergoing cardiac surgery. Methods The Cyclosporine to Protect Renal Function in Cardiac Surgery (CiPRICS) study was an investigator-initiated, double-blind, randomized, placebo-controlled, single-center study. The primary objective was to assess if cyclosporine could reduce acute kidney injury in patients undergoing coronary artery bypass grafting surgery with extracorporeal circulation. In the study, 154 patients with an estimated glomerular filtration rate of 15 to 90 ml · min–1 · 1.73 m–2 were enrolled. Study patients were randomized to receive 2.5 mg/kg cyclosporine or placebo intravenously before surgery. The primary endpoint was relative plasma cystatin C changes from the preoperative day to postoperative day 3. Secondary endpoints included biomarkers of kidney, heart, and brain injury. Results All enrolled patients were analyzed. The cyclosporine group (136.4 ± 35.6%) showed a more pronounced increase from baseline plasma cystatin C to day 3 compared to placebo (115.9 ± 30.8%), difference, 20.6% (95% CI, 10.2 to 31.2%, P &lt; 0.001). The same pattern was observed for the other renal markers. The cyclosporine group had more patients in Risk Injury Failure Loss End-stage (RIFLE) groups R (risk), I (injury), or F (failure; 31% vs. 8%, P &lt; 0.001). There were no differences in safety parameter distribution between groups. Conclusions Administration of cyclosporine did not protect coronary artery bypass grafting patients from acute kidney injury. Instead, cyclosporine caused a decrease in renal function compared to placebo that resolved after 1 month.

scholarly journals Risk Factors for Acute Kidney Injury after Coronary Artery Bypass Surgery and Its Detection Using Neutrophil Gelatinase-Associated Lipocalin

2016 ◽  
Vol 6 (3) ◽  
pp. 216-229 ◽  
Author(s):  
Oruç Alper Onk ◽  
Didem Onk ◽  
Fatih Ozcelik ◽  
Murat Gunay ◽  
Kultigin Turkmen
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Coronary Artery ◽  
Serum Creatinine ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Introduction: Acute kidney injury (AKI) is an important complication of cardiac surgery due to its high mortality. The aim of the present study was to detect the factors leading to AKI in patients who underwent coronary artery bypass surgery (CABS) and also to determine the optimal timing for detecting AKI using the biomarker neutrophil gelatinase-associated lipocalin (NGAL). Materials and Methods: The records of 375 patients who underwent CABS were reviewed in this case-control study. Ejection fraction (EF), common carotid artery intima-media thickness (CCA-IMT) and cross-clamp (C-C) time of the patients were recorded. Blood samples were taken from all patients on preoperative day 1 as well as 6, 12, 24, 36, 48 h and 7 days after operation. Biochemical parameters were studied in patients with and without AKI. Results: According to the Risk Injury Failure Loss End Stage criteria, 24 patients had renal risk, 17 had injury and 4 had failure. Postoperative 24-hour serum creatinine levels indicated the risk of renal dysfunction for only 4 patients in the AKI group. CCA-IMT, C-C time, haematocrit (HCT) and preoperative interleukin-6 levels were significantly higher in the AKI group than in the non-AKI group. Postoperative 6- and 12-hour NGAL levels in the AKI group correlated with postoperative 36-hour serum creatinine levels. The optimal cut-off values for postoperative 6- and 12-hour NGAL test were 310 and 283 ng/ml, respectively. The area under the curve was higher in the 12-hour NGAL test (p < 0.0086). Conclusion: The number of stenotic coronary arteries, EF, CCA-IMT and HCT are all important risk factors. Early postoperative NGAL results were highly specific for the early recognition of AKI.

scholarly journals Long-Term Risk of Progressive Chronic Kidney Disease in Patients with Severe Acute Kidney Injury Requiring Dialysis after Coronary Artery Bypass Surgery

2015 ◽  
Vol 5 (3) ◽  
pp. 157-163 ◽  
Author(s):  
Cynthia C. Lim ◽  
Chieh Suai Tan ◽  
Cynthia M.L. Chia ◽  
Ann Kheng Tan ◽  
Jason C.J. Choo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Coronary Artery ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Ckd Progression ◽  
Acute Dialysis

Aim: Few studies have evaluated patients after cardiac surgery for subsequent chronic kidney disease (CKD) which increases cardiovascular morbidity and mortality. This study aimed to ascertain the long-term renal outcome in adult patients with severe acute kidney injury (AKI) after coronary artery bypass graft (CABG) surgery. Methods: This is a single-center retrospective cohort study of consecutive adult patients who received acute dialysis for AKI after CABG between February 8, 2009 and January 30, 2011. Data on pre- and intra-operative factors were retrieved from electronic medical records. The primary endpoint was CKD progression as defined by dialysis dependence or doubling of serum creatinine from the pre-operative level. Secondary endpoints included in-hospital mortality and renal function at 3 months and 1 year. Results: Fifty-five patients required acute dialysis after CABG. The median age was 67 years (IQR: 61, 75), and 70.9% were male. Median pre-operative serum creatinine was 157 µmol/l (IQR: 122, 203). A total of 19 patients (34.5%) died. The median follow-up time for hospital survivors was 44.2 months (IQR: 25.0, 49.4) after surgery. Among the 36 survivors, 14 patients (38.9%) reached the primary endpoint. Patients with CKD progression had higher pre-operative serum creatinine [median 214 µmol/l (IQR: 159, 399) vs. 155 µmol/l (112, 187), p = 0.015] and lower eGFR [median 20.4 ml/min/1.73 m2 (IQR: 11.9, 38.2) vs. 39.9 ml/min/1.73 m2 (25.9, 55.5), p = 0.027] compared to those who did not have CKD progression. Conclusion: Patients with severe AKI after CABG are at high risk of long-term renal dysfunction and should be monitored regularly for deterioration.

Urine Output during Cardiopulmonary Bypass Predicts Acute Kidney Injury after Coronary Artery Bypass Grafting

2016 ◽  
Vol 19 (6) ◽  
pp. 289 ◽  
Author(s):  
Mehmet Yilmaz ◽  
Rezan Aksoy ◽  
Vildan Kilic Yilmaz ◽  
Canan Balci ◽  
Cagri Duzyol ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Urine Output ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Urinary Output ◽  
Bypass Grafting

Objective: This study evaluated the relationship between the amount of urinary output during cardiopulmonary bypass and acute kidney injury in the postoperative period of coronary artery bypass grafting.Methods: Two hundred patients with normal preoperative serum creatinine levels, operated on with isolated CABG between 2012-2014 were investigated retrospectively. The RIFLE (Risk, injury, failure, loss of function, and end-stage renal disease) risk scores were calculated for each patient in the third postoperative day. Patients were distributed into two groups in relation to the presence of acute kidney injury or not and these two groups were compared.Results: The urinary output (mL/kg/hour) during cardiopulmonary bypass in the acute kidney injury negative group was significantly higher than in the acute kidney injury positive group (P = .022). In case of a urinary output value 3.70 and lower to predict acute kidney injury positivity, sensitivity was detected as 71.43%. Results of the analysis for urinary output predict positivity of acute kidney injury.Conclusion: We suggest that urine output during cardiopulmonary bypass is a significant criteria that could predict acute kidney injury following coronary artery bypass grafting with cardiopulmonary bypass. Attempts to increase the urine output during cardiopulmonary bypass could help to maintain the renal functions during and after surgery.

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