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Leukodepletion reduces renal injury in coronary revascularization: a prospective randomized study
Augustine T M Tang1, Christos Alexiou, Jeff Hsu
1Wessex Regional Cardiac and Thoracic Unit, Southampton General Hospital, United Kingdom. gus@tang-family.org
Insights
Leukodepletion during cardiopulmonary bypass (CPB) may protect kidneys after coronary artery bypass grafting (CABG). This study found reduced renal injury markers in patients receiving leukodepletion, suggesting its potential benefit in low-risk cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Inflammation Research
Background:
- Cardiopulmonary bypass (CPB) is a known risk factor for renal failure post-coronary artery bypass grafting (CABG).
- Leukodepletion is used to mitigate CPB-associated inflammation and organ injury.
- The specific renal protective effect of leukodepletion in CABG patients has not been prospectively evaluated.
Purpose of the Study:
- To evaluate the effectiveness of leukodepletion in preventing renal injury during CPB in low-risk CABG patients.
- To assess renal tubular and glomerular injury using urinary biomarkers.
Main Methods:
- Prospective randomized trial of 40 low-risk CABG patients.
- Patients were assigned to CPB with (Group B) or without (Group A) leukodepletion.
- Renal injury assessed via urinary microalbumin:creatinine and retinol binding protein:creatinine ratios.
Main Results:
- No significant difference in mortality or overt renal complications between groups.
- Urinary excretion of microalbumin:creatinine and retinol binding protein:creatinine were significantly higher in the non-leukodepletion group (Group A).
- These markers peaked on postoperative day 1, indicating greater glomerular and tubular injury without leukodepletion.
Conclusions:
- Despite absence of clinical renal complications, leukodepletion significantly reduced subclinical renal tubule and glomeruli injury.
- Leukocytes appear to play a critical role in post-CPB renal dysfunction.
- Leukodepletion may offer a protective strategy for renal function in low-risk CABG patients.
Background:
Cardiopulmonary bypass (CPB) is an important contributor to renal failure, which is a well-recognized complication after coronary artery bypass grafting (CABG). Leukodepletion reduces CPB-associated inflammation and resultant end-organ injuries. However, its effectiveness in renal protection has not been evaluated in a prospective randomized clinical setting.
Methods:
Forty low-risk patients awaiting elective CABG with normal preoperative cardiac and renal function were prospectively randomized into those undergoing nonpulsatile CPB without (group A: n = 20) and with leukodepletion (group B: n = 20). Renal glomerular and tubular injury were assessed by urinary excretion of microalbumin and retinol binding protein (RBP) indexed to creatinine (Cr), respectively. Daily measurements were taken from admission to postoperative day 5. Fluid balance, serum creatinine, and blood urea were also monitored.
Results:
No mortality or renal complication occurred. Both groups had similar demographic makeups, Parsonnet scores, extents of coronary revascularization and, durations of CPB and aortic cross-clamping. Daily fluid balance, serum creatinine, and blood urea remained comparable in both groups throughout the study period. From equal preoperative values, a significantly higher release of urinary RBP:Cr (7,807 +/- 2,227 vs 3,942 +/- 2,528; p < 0.001) and urinary microalbumin:Cr (59.4 +/- 38.0 vs 4.7 +/- 6.7; p < 0.0001) occurred in group A, peaking on day 1 before returning to approximate baseline levels.
Conclusions:
Although clinically overt renal complications were absent, sensitive indicators revealed significantly more injury to both renal tubules and glomeruli after nonpulsatile CPB without leukodepletion. These data suggest that leukocytes play an important role in post-CPB renal dysfunction, and leukodepletion may offer some renal protection in low-risk patients during CABG.