IMPACT OF EARLY POSTOPERATIVE IMMUNONUTRITION ON RENAL IMPAIRMENT IN LOW-RISK CARDIAC SURGERY PATIENTS

Abstract

Rationale Cardiac surgeries with the use of cardiopulmonary bypass (CPB) lead to significant changes in homeostasis and a more or less pronounced immune response (1). Renal impairment is the most common clinically important complication in adult cardiac surgery patients, and is associated with increased mortality and morbidity (2). The aim of the study was to research the efficacy of early postoperative enteral immunonutrition on renal impairment after cardiac surgery. Methods A low operative risk adult patients, who underwent elective cardiac surgery, were included to the study. The patients were randomized into immunonutrition (IN) and control (C) groups. The IN group was supplemented with glutamine and antioxidants for five postoperative days. Creatinine levels were monitored in patients throughout the hospital stay - the worst parameters were recorded, analyzed and compared between the groups. Moreover renal impairment was assessed according to the RIFLE criteria. Student t-test and Mann–Whitney U test was used to compare differences between the groups. A logistic regression model was developed to assess the relationship between immunonutrition and the risk of kidney injury. Results Fifty-five patients were enrolled in the study, the mean age was 69.7±6.3 years, 28(50.9%) males, the median operative risk was 1.75%. Twenty-seven (49.1%) were in the IN group. A statistically significant decrease in postoperative creatinine clearance (worsening of renal function) was detected in the C group, accordingly 77,07 ± 23,90 vs 63,43 ± 23,31 (ml/min), p = 0,037. Based on RIFLE classification, our subjects were at risk of renal impairment in 11 cases (2 cases in the IN group and 9 cases in the C group, p = 0.023) and 5 patients had renal impairment (2 cases in the immunomodulatory group, 3 cases in the control group, p = 0.673). A logistic regression model was developed to assess the relationship between immunonutrition and the risk of kidney injury. The patients without glutamine and antioxidants supplementation had a 4.312-fold increased risk of kidney injury (p = 0,02). Conclusions Early postoperative immunonutrition has a positive effect on reducing risk of renal impairment in low-risk cardiac surgical patients. Cardiac surgeries with the use of cardiopulmonary bypass (CPB) lead to significant changes in homeostasis and a more or less pronounced immune response (1). Renal impairment is the most common clinically important complication in adult cardiac surgery patients, and is associated with increased mortality and morbidity (2). The aim of the study was to research the efficacy of early postoperative enteral immunonutrition on renal impairment after cardiac surgery. A low operative risk adult patients, who underwent elective cardiac surgery, were included to the study. The patients were randomized into immunonutrition (IN) and control (C) groups. The IN group was supplemented with glutamine and antioxidants for five postoperative days. Creatinine levels were monitored in patients throughout the hospital stay - the worst parameters were recorded, analyzed and compared between the groups. Moreover renal impairment was assessed according to the RIFLE criteria. Student t-test and Mann–Whitney U test was used to compare differences between the groups. A logistic regression model was developed to assess the relationship between immunonutrition and the risk of kidney injury. Fifty-five patients were enrolled in the study, the mean age was 69.7±6.3 years, 28(50.9%) males, the median operative risk was 1.75%. Twenty-seven (49.1%) were in the IN group. A statistically significant decrease in postoperative creatinine clearance (worsening of renal function) was detected in the C group, accordingly 77,07 ± 23,90 vs 63,43 ± 23,31 (ml/min), p = 0,037. Based on RIFLE classification, our subjects were at risk of renal impairment in 11 cases (2 cases in the IN group and 9 cases in the C group, p = 0.023) and 5 patients had renal impairment (2 cases in the immunomodulatory group, 3 cases in the control group, p = 0.673). A logistic regression model was developed to assess the relationship between immunonutrition and the risk of kidney injury. The patients without glutamine and antioxidants supplementation had a 4.312-fold increased risk of kidney injury (p = 0,02). Early postoperative immunonutrition has a positive effect on reducing risk of renal impairment in low-risk cardiac surgical patients.