Abstract

Resveratrol has been shown to preserve organ function and improve survival in hemorrhagic shock rat models. This study investigated whether seven days of oral resveratrol could improve hemodynamic response to hemorrhage and confer benefits on risk of acute kidney injury (AKI) without inducing coagulopathy in a canine model. Twelve greyhound dogs were randomly allocated to receive oral resveratrol (1000 mg/day) or placebo for seven days prior to inducing hemorrhage until a targeted mean blood pressure of ≤40 mmHg was achieved. AKI biomarkers and coagulation parameters were measured before, immediately following, and two hours after hemorrhage. Dogs were euthanized, and renal tissues were examined at the end of the experiment. All investigators were blinded to the treatment allocation. A linear mixed model was used to assess effect of resveratrol on AKI biomarkers and coagulation parameters while adjusting for volume of blood loss. A significant larger volume of blood loss was required to achieve the hypotension target in the resveratrol group compared to placebo group (median 64 vs. 55 mL/kg respectively, p = 0.041). Although histological evidence of AKI was evident in all dogs, the renal tubular injury scores were not significantly different between the two groups, neither were the AKI biomarkers. Baseline (pre-hemorrhage) maximum clot firmness on the Rotational Thromboelastometry (ROTEM®) was stronger in the resveratrol group than the placebo group (median 54 vs. 43 mm respectively, p = 0.009). In summary, seven days of oral resveratrol did not appear to induce increased bleeding risk and could improve greyhound dogs’ blood pressure tolerance to severe hemorrhage. Renal protective effect of resveratrol was, however, not observed.

Highlights

  • Perioperative hemorrhage is a major complication in surgical patients, resulting in increased morbidity and mortality [1,2,3,4]

  • Renal ultrasonography, urinalysis, complete blood count, serum creatinine (SCr), blood urea nitrogen, serum albumin concentration, platelet closure time (PCT), and Rotational Thromboelastometry (ROTEM® delta, Tem International GmbH, Munich, Germany) for all dogs were within reference intervals for adult Greyhounds [21]

  • There was no significant difference in renal and coagulation parameters between the two groups prior to initiation of resveratrol treatment (Tables 2 and 3), but there was a suggestion that seven days of resveratrol treatment could improve clot strength compared to the control prior to induction of hemorrhage (InTEM maximum clot firmness (MCF) 54 vs. 43 mm respectively; p = 0.009)(Table 3)

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Summary

Introduction

Perioperative hemorrhage is a major complication in surgical patients, resulting in increased morbidity and mortality [1,2,3,4]. Severe hemorrhage can lead to severe hypotension resulting in reduced vital organs perfusion and oxygenation [5]. Ischemia followed by reperfusion— known as ischemia-reperfusion (I-R) injury—will induce formation of free radical oxygen species, inflammatory mediators, and toxic metabolites which can cause organ injury [6,7,8]. I-R injury is one of the main causes of perioperative acute kidney injury (AKI) [9,10]. AKI is common in patients undergoing major surgery and can contribute to increased perioperative mortality [11,12,13,14,15]. Strategies capable of attenuating I-R injury due to severe hemorrhage are both clinically relevant and desirable

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