Abstract
ObjectiveAcute kidney injury after cardiac surgery is associated with mortality and morbidity. Therefore, strategies to prevent acute kidney injury are very important. The aim of this placebo-controlled randomized double-blind study was to compare the prophylactic efficacy of N-Acetylcysteine and dopamine administration in patients with pre-existing moderate renal insufficiency who were undergoing cardiopulmonary bypass.MethodsThis study included 135 patients with pre-existing moderate renal insufficiency who were scheduled for coronary artery bypass grafting surgery. Serum creatinine and GFR were recorded preoperatively and on the first and second postoperative days.ResultsOn the first and second postoperative days, the drugs used showed statistically significant differences among the creatinine groups (P<0.001). According to Tukey’s HSD, on the first and second PO, the creatinine of Group N, D and P were significantly different (P<0.001). On the first and second PO, the used drugs showed statistically significant differences among the effects of eGFR (P<0.001). According to Tukey’s HSD on the first postoperative day, the average eGFR score of Group N compared to D and P were significantly difference (P<0.001). On the second postoperative day, the eGFR of Group N and D showed no difference (P=0.37), but P showed a difference (P<0.001).ConclusionWe found that the prophylactic use of intravenous N-Acetylcysteine had a protective effect on renal function, whereas the application of renal dose dopamine did not have a protective effect in patients with pre-existing moderate renal failure.
Highlights
Acute kidney injury (AKI) after cardiac surgery is associated with mortality and morbidity[1]
The pathophysiology of AKI in patients undergoing cardiac surgery is multifactorial and includes hemodynamic factors that could lead to kidney hypoperfusion, effects of nephrotoxic drugs and consequences of the systemic inflammatory reaction induced by cardiopulmonary bypass (CPB)
The study included 135 patients with preexisting moderate renal insufficiency who were scheduled for elective coronary artery bypass grafting surgery (CABG) with CPB
Summary
Acute kidney injury (AKI) after cardiac surgery is associated with mortality and morbidity[1]. Patients undergoing cardiac surgery have been increasingly older, and they have experienced co-morbidity more frequently. Strategies to prevent AKI are extremely important. The pathophysiology of AKI in patients undergoing cardiac surgery is multifactorial and includes hemodynamic factors that could lead to kidney hypoperfusion, effects of nephrotoxic drugs and consequences of the systemic inflammatory reaction induced by cardiopulmonary bypass (CPB). These factors may contribute to renal ischemia and systemic hypoxic inflammation. During CPB, nonpulsatile flow and renal perfusion are reduced by approximately 30%, while mean arterial pressure decreases
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