The effect of chronic renal failure on plasma aprotinin levels during cardiac surgery.

Abstract

Aprotinin is a naturally occurring serine protease inhibitor with antifibrinolytic and platelet, sparing effects that reduces blood loss and transfusion requirements during cardiac surgery (1). Although plasma concentrations of aprotinin in cardiac surgical patients have been reported (228), no data describing plasma levels in patients with renal insufficiency or dialysis-dependent renal failure undergoing cardiopulmonary bypass (CPB) are available. Because aprotinin is metabolized and excreted by the kidney, renal impairment may produce a decrease in the clearance of aprotinin and an increase in its elimination half-life, resulting in unpredictable and potentially prolonged plasma levels. We describe the time course of plasma aprotinin concentrations in a Jehovah’s Witness with end-stage renal disease (ESRD) treated with continuous ambulatory peritoneal dialysis (I’D) undergoing coronary artery bypass grafting (CABG).