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Ann Thorac Surg 2003;75:906-912
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

Is kidney function altered by the duration of cardiopulmonary bypass?

Joachim Boldt, MD, PhDa*, Torsten Brennera, Andreas Lehmann, MDa, Stephan W. Suttner, MDa, Bernhard Kumle, MDa, Frank Isgro, MDb

a Department of Anesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
b Clinic of Cardiac Surgery, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany

Accepted for publication October 1, 2002.

* Address reprint requests to Dr Boldt, Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstr 79, D-67063 Ludwigshafen, Germany.
e-mail: boldtj{at}gmx.net

BACKGROUND: Cardiopulmonary bypass (CPB) is considered responsible for kidney damage. By using sensitive markers of kidney damage we assessed whether the length of CPB influences kidney function.

METHODS: In a prospective study, 50 consecutive cardiac operation patients with CPB times of less than 70 minutes were compared with 50 consecutive patients showing CPB times of more than 90 minutes. Aside from creatinine clearance and fractional excretion of sodium, urine concentrations of N-acetyl-ß-D-glucosaminidase, {alpha}1-microglobulin, glutathione transferase-{pi}, and glutathione transferase-{alpha} were measured after induction of anesthesia at the end of the operation, and on the first and second postoperative days in the intensive care unit.

RESULTS: CPB times were 58 ± 12 minutes and 116 ± 18 minutes, respectively. Hemodynamics, volume replacement, and use of catecholamines during cardiopulmonary bypass (CPB) were without significant differences between groups. Concentrations of all kidney-specific proteins increased significantly after CPB, showing the highest significant increases in the CPB more than 90 minutes group (eg, glutathione transferase-{alpha} CPB > 90 minutes from 3.0 ± 1.0 to 12.9 ± 2.9 µg/L; glutathione transferase -{alpha} CPB < 70 minutes from 2.4 ± 0.5 to 5.5 ± 1.2 µg/L). By the second postoperative day, urine concentrations of kidney-specific proteins had returned to almost baseline in the CPB less than 70 minutes patients, but remained slightly elevated in the other group.

CONCLUSIONS: Patients with CPB times more than 90 minutes showed more pronounced kidney damage than patients with CPB times less than 70 minutes as assessed by sensitive kidney-specific proteins. Whether patients with preexisting renal dysfunction undergoing prolonged CPB times would profit from renal protection strategies needs to be elucidated.




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