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Radical scavenging for renal protection in cardiac surgery

Einsatz von Antioxidantien zur Nierenprotektion während herzchirurgischer Eingriffe

  • Published:
Clinical Research in Cardiology Supplements Aims and scope

Zusammenfassung

Das akute Nierenversagen (ANV) gehört mit einer Inzidenz von bis zu 30% zu den häufigsten Komplikationen nach herzchirurgischen Eingriffen unter Verwendung der Herz-Lungen-Maschine (HLM). Bis zu 4% der Patienten mit normaler präoperativer Nierenfunktion entwickeln ein dialysepflichtiges ANV, welches mit einer hohen Mortalität zwischen 40 und 100% verbunden ist. Diese hohen Morbiditäts- und Mortalitätsraten tragen zudem zu einer enormen Steigerung der Behandlungskosten dieser Patienten bei [20]. Neben patientenabhängigen Faktoren wie hohem Alter, arteriellem Hypertonus, Diabetes mellitus und eingeschränkter linksventrikulärer Pumpfunktion stellt insbesondere die HLM-Dauer während der Operation einen Hauptrisikofaktor für ein perioperatives ANV dar. In diesem Zusammenhang ist der Bildung freier Sauerstoffradikale („reactive oxygen-derived species“; ROS) aus aktivierten Leukozyten während der extrakorporalen Zirkulation mit der HLM besondere Bedeutung beizumessen. Der Einsatz von Antioxidantien zur Verminderung des oxidativen Stresses stellt daher eine vielversprechende Strategie zur Organprotektion während herzchirugische Eingriffe unter Verwendung der HLM dar.

Summary

Renal function impairment is a common complication in cardiac surgery patients. As cardiopulmonary bypass and cardioplegic arrest are associated with formation of free radicals, which have been shown to impair various organs including the kidneys, radical scavenging may protect renal function in patients subjected to cardiac surgery on cardiopulmonary bypass.

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References

  1. Corwin HL, Sprague SM, DeLaria GA, Norusis MJ (1989) Acute renal failure associated with cardiac operations. A case-control study. J Thorac Cardiovasc Surg 98:1107–1112

    PubMed  CAS  Google Scholar 

  2. Llopart T, Lombardi R, Forselledo M, Andrade R (1997) Acute renal failure in open heart surgery. Ren Fail 19:319–323

    Article  PubMed  CAS  Google Scholar 

  3. Baudouin SV, Wiggins J, Keogh BF, Morgan CJ, Evans TW (1993) Continuous veno-venous haemofiltration following cardio-pulmonary bypass. Indications and outcome in 35 patients. Intensive Care Med 19:290–293

    Article  PubMed  CAS  Google Scholar 

  4. Schmitt H, Riehl J, Boseila A et al (1991) Acute renal failure following cardiac surgery: pre- and perioperative clinical features. Contrib Nephrol 93:98–104

    PubMed  CAS  Google Scholar 

  5. Frost L, Pedersen RS, Lund O, Hansen OK, Hansen HE (1991) Prognosis and risk factors in acute, dialysis-requiring renal failure after open-heart surgery. Scand J Thorac Cardiovasc Surg 25:161–166

    PubMed  CAS  Google Scholar 

  6. MaWhinney S, Brown ER, Malcolm J et al (2000) Identification of risk factors for increased cost, charges, and length of stay for cardiac patients. Ann Thorac Surg 70:702–710

    Article  PubMed  CAS  Google Scholar 

  7. Suen WS, Mok CK, Chiu SW et al (1998) Risk factors for development of acute renal failure (ARF) requiring dialysis in patients undergoing cardiac surgery. Angiology 49:789–800

    Article  PubMed  CAS  Google Scholar 

  8. Nuutinen L, Hollmen A (1976) Cardiopulmonary bypass time and renal function. Ann Chir Gynaecol 65:191–199

    PubMed  CAS  Google Scholar 

  9. Fischer UM, Weissenberger WK, Warters RD, Geissler HJ, Allen SJ, Mehlhorn U (2002) Impact of cardiopulmonary bypass management on postcardiac surgery renal function. Perfusion 17:401–406

    Article  PubMed  Google Scholar 

  10. Burns KE, Chu MW, Novick RJ et al (2005) Perioperative N-acetylcysteine to prevent renal dysfunction in high-risk patients undergoing cabg surgery: a randomized controlled trial. Jama 294:342–350

    Article  PubMed  CAS  Google Scholar 

  11. Fischer UM, Tossios P, Mehlhorn U (2005) Renal protection by radical scavenging in cardiac surgery patients. Curr Med Res Opin 21:1161–1164

    Article  PubMed  Google Scholar 

  12. Ulus AT, Aksoyek A, Ozkan M, Katircioglu SF, Basu S (2003) Cardiopulmonary bypass as a cause of free radical-induced oxidative stress and enhanced blood-borne isoprostanes in humans. Free Radic Biol Med 34:911–917

    Article  PubMed  CAS  Google Scholar 

  13. Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W (2000) Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med 343:180–184

    Article  PubMed  CAS  Google Scholar 

  14. Itoh Y, Yano T, Sendo T, Oishi R (2005) Clinical and experimental evidence for prevention of acute renal failure induced by radiographic contrast media. J Pharmacol Sci 97:473–488

    Article  PubMed  CAS  Google Scholar 

  15. Birck R, Krzossok S, Markowetz F, Schnulle P, van der Woude FJ, Braun C (2003) Acetylcysteine for prevention of contrast nephropathy: metaanalysis. Lancet 362:598–603

    Article  PubMed  CAS  Google Scholar 

  16. Isenbarger DW, Kent SM, O'Malley PG (2003) Meta-analysis of randomized clinical trials on the usefulness of acetylcysteine for prevention of contrast nephropathy. Am J Cardiol 92:1454–1458

    Article  PubMed  CAS  Google Scholar 

  17. Alonso A, Lau J, Jaber BL, Weintraub A, Sarnak MJ (2004) Prevention of radiocontrast nephropathy with N-acetylcysteine in patients with chronic kidney disease: a meta-analysis of randomized, controlled trials. Am J Kidney Dis 43:1–9

    Article  PubMed  CAS  Google Scholar 

  18. Pannu N, Manns B, Lee H, Tonelli M (2004) Systematic review of the impact of N-acetylcysteine on contrast nephropathy. Kidney Int 65:1366–1374

    Article  PubMed  CAS  Google Scholar 

  19. Spargias K, Alexopoulos E, Kyrzopoulos S et al (2004) Ascorbic acid prevents contrast-mediated nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. Circulation 110:2837–2842

    Article  PubMed  CAS  Google Scholar 

  20. Tossios P, Bloch W, Huebner A et al (2003) N-acetylcysteine prevents reactive oxygen species-mediated myocardial stress in patients undergoing cardiac surgery: results of a randomized, double-blind, placebo-controlled clinical trial. J Thorac Cardiovasc Surg 126:1513–1520

    Article  PubMed  CAS  Google Scholar 

  21. Rinder CS, Fontes M, Mathew JP, Rinder HM, Smith BR (2003) Neutrophil CD11b upregulation during cardiopulmonary bypass is associated with postoperative renal injury. Ann Thorac Surg 75:899–905

    Article  PubMed  Google Scholar 

  22. Tang AT, Alexiou C, Hsu J, Sheppard SV, Haw MP, Ohri SK (2002) Leukodepletion reduces renal injury in coronary revascularization: a prospective randomized study. Ann Thorac Surg 74:372–377; discussion 377

    Article  PubMed  Google Scholar 

  23. Andersen LW, Thiis J, Kharazmi A, Rygg I (1995) The role of N-acetylcystein administration on the oxidative response of neutrophils during cardiopulmonary bypass. Perfusion 10:21–26

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, University of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany

    U. M. Fischer MD & U. Mehlhorn

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  1. U. M. Fischer MD
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  2. U. Mehlhorn
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Correspondence to U. M. Fischer MD.

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Fischer, U.M., Mehlhorn, U. Radical scavenging for renal protection in cardiac surgery. Clin Res Cardiol Suppl 2 (Suppl 1), S81–S84 (2007). https://doi.org/10.1007/s11789-006-0042-9

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  • DOI: https://doi.org/10.1007/s11789-006-0042-9

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