OJAnes  Vol.3 No.9 , November 2013
Renal Function after Coronary Artery Bypass Graft Using Dexmedetomidine
Abstract: Acute kidney injury (AKI) is defined by 0.3 mg/dL increase in serum creatinine (SCr) and is associated with higher incidence of postoperative mortality after coronary artery bypass graft (CABG). There are few clinical studies on the effect of dexmedetomidine (DEX) on renal function. We evaluated AKI after coronary artery bypass graft with and without cardiopulmonary bypass (CPB) under anesthesia with DEX. Method: In this retrospective study, we performed serial analysis of serum creatinine (SCr) up to 48 hours after surgery in 286 patients who underwent CABG. We tested the similarities between groups, evaluating patients separately for use of CPB and DEX. Each patient was evaluated for his or her SCr at the following points in time: preoperative, immediately postoperative, 24 hours postoperative, and 48 hours postoperative. Preoperative SCr was used as the baseline value for each patient. If the SCr increased ≥0.3 mg/dL in at least one of the periods, the patient was classified as having AKI. We also assessed the risk for AKI in patients with altered preoperative SCr (values between 1.1 to 2.0 mg/dL for women or 1.3 to 2.0 mg/dL for men) compared to patients with normal SCr. Results: The groups were similar for preoperative weight, age, and altered SCr. Patients were anesthetized with DEX and who underwent CPB exhibited higher incidence of AKI (p = 0.043). Without CPB, there was higher incidence of AKI after using DEX (p = 0.066). Conclusion: Anaesthesia with DEX increased the incidence of AKI after myocardial revascularization surgery in patients who underwent CPB.
Cite this paper: A. Martucci and Y. Machado Castiglia, "Renal Function after Coronary Artery Bypass Graft Using Dexmedetomidine," Open Journal of Anesthesiology, Vol. 3 No. 9, 2013, pp. 421-426. doi: 10.4236/ojanes.2013.39088.

[1]   [1] R. L. Mehta, J. A. Kellum, S. V. Shah, B. A. Molitoris, C. Ronco, D. G. Warnock and A. Levin, “Acute Kidney Injury Network: Report of an Initiative to Improve Outcomes in Acute Kidney Injury,” Critical Care, Vol. 11, No. 2, 2007, p. R31.

[2]   “American Society of Nephrology Renal Research Report,” Journal of the American Society of Nephrology, Vol. 16, No. 7, 2005, pp.1886-1903.

[3]   I. Bahar, A. Akgul, M. A. Ozatik, K. M. Vural, A. E. Demirbag, M. Boran and O. Tasdemir, “Acute Renal Failure Following Open Heart Surgery: Risk Factors and Prognosis,” Perfusion, Vol. 20, No. 6, 2005, pp. 317-322.

[4]   G. M. Chertow, E. Burdick, M. Honour, J. V. Bonventre and D. W. Bates, “Acute Kidney Injury, Mortality, Length of Stay, and Costs in Hospitalized Patients,” Journal of the American Society of Nephrology, Vol. 16, No. 11, 2005, pp. 3365-3370.

[5]   D. A. Tolpin, C. D. Collard, V. V. Lee, S. S. Virani, P. M. Allison, M. A. Elayda and W. Pan, “Subclinical Changes in Serum Creatinine and Mortality after Coronary Artery Bypass Grafting,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 143, No. 3, 2012, pp. 682-688.

[6]   A. B. Kumar and M. Suneja, “Cardiopulmonary BypassAssociated Acute Kidney Injury,” Anesthesiology, Vol. 114, No. 4, 2011, pp. 964-970.

[7]   D. J. Brito, V. J. Nina, R. V. Nina, J. A. Figueiredo Neto, M. I. Oliveira, J. V. Salgado, J. S. Lages and N. Salgado Filho, “Prevalence and Risk Factors for Acute Renal Failure in the Postoperative of Coronary Artery Bypass Grafting,” The Revista Brasileira de Cirurgia Cardiovascular, Vol. 24, No. 3, 2009, pp. 297-304.

[8]   M. H. Rosner and M. D. Okusa, “Acute Kidney Injury Associated with Cardiac Surgery,” Clinical Journal of the American Society of Nephrology, Vol. 1, No. 1, 2006, pp. 19-32.

[9]   R. Ascione, G. Nason, S. Al-Ruzzeh, C. Ko, F. Ciulli and G. D. Angelini, “Coronary Revascularization with or without Cardiopulmonary Bypass in Patients with Preoperative Nondialysis-Dependent Renal Insufficiency,” The Annals of Thoracic Surgery, Vol. 72, No. 6, 2001, pp. 2020-2025.

[10]   G. Asimakopoulos, A. P. Karagounis, O. Valencia, N. Alexander, M. Howlader, M. A. Sarsam and V. Chandrasekaran, “Renal Function after Cardiac Surgery offVersus On-Pump Coronary Artery Bypass: Analysis Using the Cockroft-Gault Formula for Estimating Creatinine Clearance,” The Annals of Thoracic Surgery, Vol. 79, No. 6, 2005, pp. 2024-2031.

[11]   J. W. Sear, “Kidney Dysfunction in the Postoperative Period,” British Journal of Anaesthesia, Vol. 95, No. 1, 2005, pp. 20-32.

[12]   F. O. Santos, M. A. Silveira, R. B. Maia, M. D. Monteiro and R. Martinelli, “Acute Renal Failure after Coronary Artery Bypass Surgery with Extracorporeal Circulation— Incidence, Risk Factors, and Mortality,” Arquivos Brasileiros de Cardiologia, Vol. 83, No. 2, 2004, pp. 150-154; 145-159.

[13]   A. C. Kochi, A. S. Martins, M. C. Lima, L. C. Martin and A. L. Balbi, “[Preoperative Factors for the Development of Acute Kidney Injury after Cardiac Surgery: Prospective study],” Revista da Associação Médica Brasileira, Vol. 54, No. 3, 2008, pp. 208-213.

[14]   M. Boodhwani, F. D. Rubens, D. Wozny and H. J. Nathan, “Effects of Mild Hypothermia and Rewarming on Renal Function after Coronary Artery Bypass Grafting,” The Annals of Thoracic Surgery, Vol. 87, No. 2, 2009, pp. 489-495.

[15]   A. Kourliouros, O. Valencia, S. D. Phillips, P. O. Collinson, J. P. van Besouw and M. Jahangiri, “Low Cardiopulmonary Bypass Perfusion Temperatures Are Associated with Acute Kidney Injury Following Coronary Artery Bypass Surgery,” European Journal Cardio-Thoracic Surgery, Vol. 37, No. 3, 2010, pp. 704-709.

[16]   M. D. Okusa, “The Inflamatory Cascade in Acute Ischemic Renal Failure,” Nepron, Vol. 90, No. 2, 2002, pp. 133-138.

[17]   J. E. Hall, T. D. Uhrich, J. A. Barney, S. R. Arain and T. J. Ebert, “Sedative, Amnestic, and Analgesic Properties of Small-Dose Dexmedetomidine Infusions,” Anesthesia & Analgesia, Vol. 90, No. 3, 2000, pp. 699-705.

[18]   V. Malhotra, V. Sudheendra, J. O’Hara and S. Diwan, “Anesthesia and the Renal and Genitourinary Systems.” In: R. D. Miller, Ed., Miller’s Anesthesia, Churchill Livingstone Elsevier, Philadelphia, 2009. pp. 2105-2134.

[19]   J. G. Reves, P. S. A. Glass, D. A. Lubarsky, M. D. McEvoy and R. Martinez-Ruiz, “Intravenous Anesthetics,” In: R. D. Miller, Ed., Miller’s Anesthesia, Churchill Livingstone Elsevier, Philadelphia, 2009. pp. 719-768.

[20]   J. Jalonen, M. Hynynen, A. Kuitunen, H. Heikkila, J. Perttila, M. Salmenpera, M. Valtonen, R. Aantaa and A. Kallio, “Dexmedetomidine as an Anesthetic Adjunct in Coronary Artery Bypass Grafting,” Anesthesiology, Vol. 86, No. 2, 1997, pp. 331-345.

[21]   P. J. Kulka, M. Tryba and M. Zenz, “Preoperative Alpha2-Adrenergic Receptor Agonists Prevent the Deterioration of Renal Function after Cardiac Surgery: Results of a Randomized, Controlled Trial,” Critical Care Medicine, Vol. 24, No. 6, 1996, pp. 947-952.

[22]   R. D. Lindeman and R. Goldman, “Anatomic and Physiologic age Changes in the Kidney,” Experimental Gerontology, Vol. 21, No. 4-5, 1986, pp. 379-406.

[23]   M. Bennett, C. L. Dent, Q. Ma, S. Dastrala, F. Grenier, R. Workman, H. Syed, S. Ali, J. Barasch and P. Devarajan, “Urine NGAL Predicts Severity of Acute Kidney Injury after Cardiac Surgery: A Prospective Study,” Clinical Journal of the American Society of Nephrology, Vol. 3, No. 3, 2008, pp. 665-673.

[24]   M. L. Felicio, R. R. Andrade, Y. M. Castiglia, M. A. Silva, P. T. Vianna and A. S. Martins, “Cystatin C and Glomerular Filtration Rate in the Cardiac Surgery with Cardiopulmonary Bypass,” The Revista Brasileira de Cirurgia Cardiovascular, Vol. 24, No. 3, 2009, pp. 305-311.

[25]   W. K. Han, G. Wagener, Y. Zhu, S. Wang and H. T. Lee, “Urinary biomarkers in the early detection of acute kidney injury after cardiac surgery,” Clinical Journal of the American Society of Nephrology, Vol. 4, No. 5, 2009, pp. 873-882.

[26]   S. S. Han, K. J. Kang, S. J. Kwon, et al. “Additional Role of Urine Output Criterion in Defining Acute Kidney Injury,” Nephrology Dialysis Transplantation, Vol. 27, No. 1, 2012 pp. 161-165.

[27]   R. D. Perrone, N. E. Madias and A. S. Levey, “Serum Creatinine as an Index of Renal Function: New Insights into Old Concepts,” Clinical Chemistry, Vol. 38, No. 10, 1992, pp. 1933-1953.

[28]   M. I. Stallwood, A. D. Grayson, K. Mills and N. D. Scawn, “Acute Renal Failure in Coronary Artery Bypass Surgery: Independent Effect of Cardiopulmonary Bypass,” The Annals of Thoracic Surgery, Vol. 77, No. 3, 2004, pp. 968-972.

[29]   F. de Somer, J. W. Mulholland, M. R. Bryan, T. Aloisio, G. J. Van Nooten and M. Ranucci, “O2 delivery and CO2 Production during Cardiopulmonary Bypass as Determinants of Acute Kidney Injury: Time for a Goal-Directed Perfusion Management?” Critical Care, Vol. 15, No. 4, 2011, p. R192.

[30]   J. Gu, P. Sun, H. Zhao, H. R. Watts, R. D. Sanders, N. Terrando, P. Xia, M. Maze and D. Ma, “Dexmedetomidine Provides Renoprotection against Ischemia-Reperfusion Injury in Mice,” Critical Care, Vol. 15, No. 3, 2011, p. R153.

[31]   M. A. Marangoni, A. Hausch, P. T. Vianna, J. R. Braz, R. M. Viero and Y. M. Castiglia, “Renal Function and Histology after Acute Hemorrhage in Rats under Dexmedetomidine Action,” Acta Cirurgica Brasileira, Vol. 22, No. 4, 2007, pp. 291-298.