| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Eur J Cardiothorac Surg 2005;27:893-898
© 2005 Elsevier Science NL
a Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford OX3 9DU, UK
b Department for Statistics in Medicine, University of Oxford, Oxford, UK
c Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford OX3 9DU, UK
Received 17 August 2004; received in revised form 7 December 2004; accepted 29 December 2004.
* Corresponding author. Tel.: +44 1865 221121; fax: +44 1865 220244. (E-mail: david.taggart{at}orh.nhs.uk).
Objective: Cardiopulmonary bypass is regarded as an important contributor to renal injury, whereas off-pump surgery is considered less damaging. Cystatin C, a cystine protease inhibitor, is more sensitive and specific than creatinine in the assessment of renal function. We assessed the value of Cystatin C in quantifying clinical and subclinical renal injury following on-pump and off-pump cardiac surgery. Methods: Sixty consecutive patients were recruited: 30 patients undergoing on-pump CABG and 30 patients undergoing off-pump CABG. Blood samples were collected pre-operatively and on days 1, 2 and 4 postoperatively to measure serum creatinine and serum Cystatin C. Urinary samples were collected concurrently to measure microalbumin and N-acetyl-ß-glucosaminidase, denoting changes in renal glomerular and tubular function respectively. Results: The off-pump group were older (65±11 vs. 61±8 years; P=0.046), had a higher mean Parsonnet score (9.4±6.2 vs. 5.4±3.6, P<0.01) and received fewer grafts (2.4±0.9 vs. 3.1±0.7; P<0.01) compared to the on-pump group. The groups were otherwise matched with respect to preoperative renal function and left ventricular function. Patients undergoing on-pump CABG had greater increases in all four parameters of renal injury. Adjustment for preoperative differences increased the size and significance of the effect of off-pump vs. on-pump surgery (percent difference 13%; 95% CI 2–26 for creatinine, and 16%; 95% CI 4–29 for Cystatin C). Cystatin and creatinine were strongly correlated with each other. Conclusions: Avoidance of cardiopulmonary bypass may reduce renal injury particularly in higher risk patients. Cystatin C proved to be a simple and sensitive measure of overall renal function and can be used in the routine assessment of renoprotective strategies.
Key Words: Renal injury • Cardiopulmonary bypass • Coronary artery bypass grafting • Off-pump
This article has been cited by other articles:
|
|
 |
|
  M. Haase, A. Haase-Fielitz, S. Ratnaike, M. C. Reade, S. M. Bagshaw, S. Morgera, D. Dragun, and R. Bellomo N-Acetylcysteine does not artifactually lower plasma creatinine concentration Nephrol. Dial. Transplant., May 1, 2008; 23(5): 1581 - 1587. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. G Raja and G. D Dreyfus Current Status of Off-pump Coronary Artery Bypass Surgery Asian Cardiovasc Thorac Ann, April 1, 2008; 16(2): 164 - 178. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Zhu, R. Yin, H. Shao, G. Dong, L. Luo, and H. Jing N-acetylcysteine to ameliorate acute renal injury in a rat cardiopulmonary bypass model J. Thorac. Cardiovasc. Surg., March 1, 2007; 133(3): 696 - 703. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Abu-Omar and C. Ratnatunga Cardiopulmonary Bypass and Renal Injury Perfusion, July 1, 2006; 21(4): 209 - 213. [Abstract] [PDF]
|
|
|
|
 |
|
 F.-X. Schmid, N. Vudattu, B. Floerchinger, M. Hilker, G. Eissner, M. Hoenicka, E. Holler, and D. E. Birnbaum Endothelial apoptosis and circulating endothelial cells after bypass grafting with and without cardiopulmonary bypass. Eur. J. Cardiothorac. Surg., April 1, 2006; 29(4): 496 - 500. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
