Key result
Cardiopulmonary bypass with moderate hypothermia significantly increased glomerular permeability, evidenced by elevated urine albumin/creatinine ratio during bypass and significant proteinuria up to 48 hours postoperatively.
Why the study?
The study was conducted to evaluate the effects of cardiopulmonary bypass perfusion temperature on renal function parameters and to detect renal complications of cardiopulmonary bypass.
Cohort (n=30)
No
p-value: p=<0.001
Cardiopulmonary bypass with moderate hypothermia during valvular surgery transiently increases glomerular permeability and carries a 40% risk of mostly reversible acute kidney injury.
May warrant enhanced renal monitoring during valvular surgery with moderate hypothermia CPB; leaves open optimal bypass temperature for kidney protection.
Aims and objective: The primary objective of this investigation was to study the effects of cardiopulmonary bypass (CPB) perfusion temperature on renal function parameters [serum creatinine, creatinine clearance, urine albumin, urine protein, and urine albumin/creatinine ratio (ACR)]. The secondary objective was to detect renal complications of CPB. Materials and methods: This is a prospective longitudinal study of 30 adult patients (17 men, 13 women; mean age, 53.37 ± 16.02 years) who underwent valvular heart surgery [with or without coronary artery bypass grafting (CABG)]. Serum creatinine, creatinine clearance, urine protein, urine albumin, and urine ACR were collected during CPB (at 28 C, 32 C, and 37 C) and postoperatively (at 12 hours, 24 hours, and 48 hours). Data were analyzed using one-way repeatedmeasures analysis of variance (ANOVA). A significant ANOVA was followed by a BonferronieHolm post hoc test. Results: Although serum creatinine ( p < 0.001) and creatinine clearance ( p¼0.0016) underwent a significant ANOVA change ( p < 0.001 and p¼0.0016, respectively) after CPB, there was no statistically significant change compared with their baseline values. Urine ACR showed a significant change at 28 C (p < 0.01), 32 C (p < 0.01), and 37 C (p < 0.05) as compared with baseline values. No significant change in urine albumin was observed during CPB or up to 24 hours. A significant change occurred after 48 hours of CPB ( p < 0.05). A significant increase in urine protein was noted after CPB at 12 hours ( p < 0.01), 24 hours ( p < 0.01), and 48 hours ( p < 0.01). Overall, 12 (40%) patients had acute kidney injury (AKI). Ten (33.33%) patients had stage I AKI, one patient progressed to AKI stage II, and another to AKI stage III. Of the 10 patients who had stage I AKI, eight had complete recovery within 48 hours. Conclusions: CPB with moderate hypothermia for valvular heart surgeries can be performed safely in patients with adequate renal functional reserve. The glomerular permeability across the Bowman’s capsule increases after CPB as evidenced by significant proteinuria at 12 hours and increased albuminuria at 48 hours after surgery. There is an increased risk of transient stage I AKI after CPB, from which patients recover within 48 hours.
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Ramkumar et al. (2019) conducted a cohort in Valvular heart disease requiring surgery (n=30). Cardiopulmonary bypass with moderate hypothermia vs. Preoperative baseline was evaluated on Changes in renal function parameters (serum creatinine, creatinine clearance, urine albumin, urine protein, and urine albumin/creatinine ratio) (p=<0.001). Cardiopulmonary bypass with moderate hypothermia significantly increased glomerular permeability, evidenced by elevated urine albumin/creatinine ratio during bypass and significant proteinuria up to 48 hours postoperatively.
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