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Effect of pentoxifylline on preventing acute kidney injury after cardiac surgery by measuring urinary neutrophil gelatinase - associated lipocalin.

Barkhordari K, Karimi A, Shafiee A, Soltaninia H, Khatami MR, Abbasi K, Yousefshahi F, Haghighat B, Brown V - J Cardiothorac Surg (2011)

Bottom Line: The rise of UNGAL in these patients may be reduced by administration of PTX although we did not show significance.Overall, we suggest future studies with larger sample sizes to elucidate this effect and determine the different aspects of administrating PTX.ISRCTN: IRCT138807302622N1.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology and Critical Care, Tehran Heart Center, Tehran University of Medical Sciences, Iran. kbarkhordari@sina.tums.ac.ir

ABSTRACT

Background: Based on Acute Kidney Injury Network (AKIN) criteria, we considered acute kidney injury (AKI) as an absolute increase in the serum creatinine (sCr) level of more than or equal to 0.3 mg/dl or 50%. The introduction of Urinary neutrophil gelatinase-associated lipocalin (UNGAL) has conferred earlier diagnosis of AKI. Pentoxifylline (PTX), a non-specific phosphodiesterase inhibitor, can suppress the production of some factors of inflammatory response and presumably prevent AKI. We examined the PTX on the development of AKI in cardiac surgery patients by measuring the levels of UNGAL.

Materials and methods: We performed a double blind randomized clinical trial, enrolling 28 consecutive patients undergoing elective coronary artery bypass graft (CABG) surgery. Patients were divided into two groups, one to receive PTX 5 mg/kg intravenous bolus injection, followed by 1.5 mg/kg/h continuous intravenous infusion until 3 hours after cessation of CPB and the other group received placebo. UNGAL was measured before, 3 and 24 hours after surgery. In addition serum creatinine was measured before and 24, 48, 72 and 96 hours after surgery and C-reactive protein (CRP) only 24 hours postoperatively.

Results: Both groups did not differ in demographic and baseline characteristics. 12 patients developed AKI 48 hours after surgery; 5 of them were in the intervention group and 7 in the control group (p= 0.445). There was an increase of UNGAL in both groups postoperatively, although not significant. Mean sCr was significantly increased in the control group at 24 and 48 hours after surgery (24-h mean: 0.79 ± 0.18 mg/dl vs. 1.03 ± 0.43 mg/dl, P value = 0.02; 48-h mean: 1.17 ± 0.24 mg/dl vs. 0.98 ± 0.20 mg/dl, P value = 0.03, respectively). PTX had a positive effect in preventing AKI reflecting in changes in sCr, and the increase of UNGAL was consistent with the emergence of AKI (Pearson's correlation = 0.30).

Conclusion: Our study demonstrates a weak correlation between UNGAL and sCr after cardiac surgery. The rise of UNGAL in these patients may be reduced by administration of PTX although we did not show significance. PTX could reduce the occurrence of AKI as determined by attenuation of sCr rise without causing hemodynamic instability or increased bleeding. Overall, we suggest future studies with larger sample sizes to elucidate this effect and determine the different aspects of administrating PTX.

Trial registration: ISRCTN: IRCT138807302622N1.

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Comparing sCr level before and after CABG between the intervention group and the controls by median/interquartile range. Asterisks show significant difference.
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Figure 2: Comparing sCr level before and after CABG between the intervention group and the controls by median/interquartile range. Asterisks show significant difference.

Mentions: There was a significant difference regarding mean sCr levels 24 and 48 hours postoperatively (p = 0.02 and p = 0.03, respectively). The level of sCr in 72 and 96 hours was not different between the groups. (p = 0.12 and p = 0.69, respectively) (Figure 2).


Effect of pentoxifylline on preventing acute kidney injury after cardiac surgery by measuring urinary neutrophil gelatinase - associated lipocalin.

Barkhordari K, Karimi A, Shafiee A, Soltaninia H, Khatami MR, Abbasi K, Yousefshahi F, Haghighat B, Brown V - J Cardiothorac Surg (2011)

Comparing sCr level before and after CABG between the intervention group and the controls by median/interquartile range. Asterisks show significant difference.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3037303&req=5

Figure 2: Comparing sCr level before and after CABG between the intervention group and the controls by median/interquartile range. Asterisks show significant difference.
Mentions: There was a significant difference regarding mean sCr levels 24 and 48 hours postoperatively (p = 0.02 and p = 0.03, respectively). The level of sCr in 72 and 96 hours was not different between the groups. (p = 0.12 and p = 0.69, respectively) (Figure 2).

Bottom Line: The rise of UNGAL in these patients may be reduced by administration of PTX although we did not show significance.Overall, we suggest future studies with larger sample sizes to elucidate this effect and determine the different aspects of administrating PTX.ISRCTN: IRCT138807302622N1.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology and Critical Care, Tehran Heart Center, Tehran University of Medical Sciences, Iran. kbarkhordari@sina.tums.ac.ir

ABSTRACT

Background: Based on Acute Kidney Injury Network (AKIN) criteria, we considered acute kidney injury (AKI) as an absolute increase in the serum creatinine (sCr) level of more than or equal to 0.3 mg/dl or 50%. The introduction of Urinary neutrophil gelatinase-associated lipocalin (UNGAL) has conferred earlier diagnosis of AKI. Pentoxifylline (PTX), a non-specific phosphodiesterase inhibitor, can suppress the production of some factors of inflammatory response and presumably prevent AKI. We examined the PTX on the development of AKI in cardiac surgery patients by measuring the levels of UNGAL.

Materials and methods: We performed a double blind randomized clinical trial, enrolling 28 consecutive patients undergoing elective coronary artery bypass graft (CABG) surgery. Patients were divided into two groups, one to receive PTX 5 mg/kg intravenous bolus injection, followed by 1.5 mg/kg/h continuous intravenous infusion until 3 hours after cessation of CPB and the other group received placebo. UNGAL was measured before, 3 and 24 hours after surgery. In addition serum creatinine was measured before and 24, 48, 72 and 96 hours after surgery and C-reactive protein (CRP) only 24 hours postoperatively.

Results: Both groups did not differ in demographic and baseline characteristics. 12 patients developed AKI 48 hours after surgery; 5 of them were in the intervention group and 7 in the control group (p= 0.445). There was an increase of UNGAL in both groups postoperatively, although not significant. Mean sCr was significantly increased in the control group at 24 and 48 hours after surgery (24-h mean: 0.79 ± 0.18 mg/dl vs. 1.03 ± 0.43 mg/dl, P value = 0.02; 48-h mean: 1.17 ± 0.24 mg/dl vs. 0.98 ± 0.20 mg/dl, P value = 0.03, respectively). PTX had a positive effect in preventing AKI reflecting in changes in sCr, and the increase of UNGAL was consistent with the emergence of AKI (Pearson's correlation = 0.30).

Conclusion: Our study demonstrates a weak correlation between UNGAL and sCr after cardiac surgery. The rise of UNGAL in these patients may be reduced by administration of PTX although we did not show significance. PTX could reduce the occurrence of AKI as determined by attenuation of sCr rise without causing hemodynamic instability or increased bleeding. Overall, we suggest future studies with larger sample sizes to elucidate this effect and determine the different aspects of administrating PTX.

Trial registration: ISRCTN: IRCT138807302622N1.

Show MeSH
Related in: MedlinePlus