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Kolsrud O, Barbu M, Dellgren G, et al. Dextran-based priming solution during cardiopulmonary bypass attenuates renal tubular injury-A secondary analysis of randomized controlled trial in adult cardiac surgery patients. Acta Anaesthesiol Scand. 2021;66(1):40-47doi: 10.1111/aas.13975.
Kolsrud, O., Barbu, M., Dellgren, G., Björk, K., Corderfeldt, A., Thoren, A., Jeppsson, A., & Ricksten, S. E. (2022). Dextran-based priming solution during cardiopulmonary bypass attenuates renal tubular injury-A secondary analysis of randomized controlled trial in adult cardiac surgery patients. Acta anaesthesiologica Scandinavica, 66(1), 40-47. https://doi.org/10.1111/aas.13975
Kolsrud, Oscar, et al. "Dextran-based priming solution during cardiopulmonary bypass attenuates renal tubular injury-A secondary analysis of randomized controlled trial in adult cardiac surgery patients." Acta anaesthesiologica Scandinavica vol. 66,1 (2022): 40-47. doi: https://doi.org/10.1111/aas.13975
Kolsrud O, Barbu M, Dellgren G, Björk K, Corderfeldt A, Thoren A, Jeppsson A, Ricksten SE. Dextran-based priming solution during cardiopulmonary bypass attenuates renal tubular injury-A secondary analysis of randomized controlled trial in adult cardiac surgery patients. Acta Anaesthesiol Scand. 2022 Jan;66(1):40-47. doi: 10.1111/aas.13975. Epub 2021 Sep 06. PMID: 34424995.
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Acta Anaesthesiol Scand. 2022 Jan;66(1):40-47. doi: 10.1111/aas.13975. Epub 2021 Sep 06.

Dextran-based priming solution during cardiopulmonary bypass attenuates renal tubular injury-A secondary analysis of randomized controlled trial in adult cardiac surgery patients.

Acta anaesthesiologica Scandinavica

Oscar Kolsrud, Mikael Barbu, Göran Dellgren, Kerstin Björk, Anna Corderfeldt, Anders Thoren, Anders Jeppsson, Sven-Erik Ricksten

Affiliations

  1. Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
  2. Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
  3. Department of Cardiology, Karlskrona Hospital, Karlskrona, Sweden.
  4. Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
  5. Departments of Cardiothoracic Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.

PMID: 34424995 DOI: 10.1111/aas.13975

Abstract

BACKGROUND: Acute kidney injury (AKI) is a well-known complication after cardiac surgery and cardiopulmonary bypass (CPB). In the present secondary analysis of a blinded randomized controlled trial, we evaluated the effects of a colloid-based versus a conventional crystalloid-based prime on tubular injury and postoperative renal function in patients undergoing cardiac surgery with CPB.

METHODS: Eighty-four adult patients undergoing cardiac surgery with CPB were randomized to receive either a crystalloid- or colloid- (dextran 40) based CPB priming solution. The crystalloid solution was based on Ringer-Acetate plus mannitol. The tubular injury biomarker, N-acetyl-b-D-glucosaminidase (NAG), serum creatinine and diuresis were measured before, during and after CPB. The incidence of AKI was assessed according to the KDIGO criteria.

RESULTS: The urinary-NAG/urinary-creatinine ratio rose in both groups during and after CPB, with a more pronounced increase in the crystalloid group (p = .038). One hour after CPB, the urinary-NAG/urinary-creatinine ratio was 88% higher in the crystalloid group (4.7 ± 6.3 vs. 2.5 ± 2.7, p = .045). Patients that received the dextran 40-based priming solution had a significantly lower intraoperative diuresis (p < .001) compared to the crystalloid group. The incidence of AKI was 18% in the colloid and 22% in the crystalloid group (p = .66). Postoperative serum creatinine did not differ between groups.

CONCLUSIONS: In patients undergoing cardiac surgery with CPB, colloid-based priming solution (dextran 40) induced less renal tubular injury compared to a crystalloid-based priming solution. Whether a colloid-based priming solution will improve renal outcome in high-risk cardiac surgery, or not, needs to be evaluated in future studies on higher risk cardiac surgery patients.

© 2021 Acta Anaesthesiologica Scandinavica Foundation.

Keywords: acute tubular injury; cardiac surgery; cardiopulmonary bypass; colloid prime; kidney function

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