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

• Published in: European journal of cardio-thoracic surgery Vol. 31; no. 2; pp. 290 - 297
• Main Authors: Kaya, Kaan, Oğuz, Mehmet, Akar, Ahmet Ruchan, Durdu, Serkan, Aslan, Alp, Erturk, Sebnem, Taşöz, Refik, Ozyurda, Umit
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Science B.V 01-02-2007; Elsevier Science
• Subjects: Acute Kidney Injury - etiology; Acute Kidney Injury - prevention & control; Aged; Biological and medical sciences; Biomarkers - blood; Cardiology. Vascular system; Cardiopulmonary Bypass; Cardiopulmonary bypass (CPB); Complications; Coronary Artery Bypass - adverse effects; Coronary artery bypass grafting (CABG); Coronary Disease - surgery; Coronary heart disease; Creatinine - blood; Female; Glomerular filtration rate; Glomerular Filtration Rate - drug effects; Heart; Humans; Kidney; Kidney - blood supply; Male; Medical sciences; Middle Aged; Nitroprusside - therapeutic use; Prospective Studies; Reperfusion Injury - prevention & control; Sodium nitroprusside; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Vasodilator Agents - therapeutic use; Sodium nitroprusside; Coronary artery bypass grafting (CABG); Cardiopulmonary bypass (CPB); Complications; Kidney; Glomerular filtration rate; Renal function; Vasodilator agent; Cardiovascular disease; Glomerular nitration rate; Epidemiology; Prospective; Infusion; Randomization; Reperfusion; Aortocoronary; Complication; Clinical trial; Graft; Human; Kidney disease; Nitration; Urinary system disease; Rate; Patient; Period; Coronary heart disease; Cardiopulmonary bypass; Treatment; Coronary artery bypass; Bypass; Perfusion; Antihypertensive agent
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2006.11.015

Objective: Acute renal failure remains a common and serious complication of cardiac surgery. In this randomized trial, we aimed to assess whether sodium nitroprusside (SNP) infusion during cardiopulmonary bypass (CPB) could prevent renal dysfunction after coronary artery bypass grafting (CABG) surgery. Methods: Between October 2004 and May 2006, 240 consecutive patients with stable angina undergoing elective CABG for multi-vessel coronary artery disease were prospectively randomized into control (n = 116, 72 men, mean age 61.3 ± 9.7 years) or SNP groups (n = 124, 81 men, 60.8 ± 10.8 years). SNP group received SNP after initiation of rewarming period during CPB at a dose of 0.1 mg/kg/h and the infusion was concluded by weaning from CPB. The anesthetic and CPB regimes were standardized. Blood urea nitrogen (BUN), serum creatinine (SCr), estimated glomerular filtration rate (eGFR), creatinine clearance (CCr), urine output, serum cardiac specific troponin I (cTnI), creatine kinase cardiac isoenzyme (CKMB), and CPK were measured preoperatively and daily until day 5 after surgery. Results: There were no differences in baseline levels of BUN, SCr, eGFR, CCr, cTnI, CKMB, CPK levels and EuroSCORES between the groups. Although the durations of cross clamp, CPB times, and postoperative cardiac enzymes were similar in both groups; in the control group, there was a significantly lower urine excretion during CPB (p = 0.002) and the operation (p = 0.041). Peak postoperative SCr levels were significantly (p = 0.001) lower in the SNP group than in the control group (1.29 ± 0.28 vs 1.42 ± 0.34 mg/dl). The incidence of ≥50%ΔSCr was significantly higher in the control group when compared with the SNP group (35.3 vs 13.7%, p ≪ 0.001). Development of new CCr less than 50 ml/min postoperatively was significantly higher in the control group compared with the SNP group (14 vs 38%, p ≪ 0.001). Conclusion: 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.