Effects of allopurinol and vitamin E on renal function in patients with cardiac coronary artery bypass grafts

Abstract

Background:Acute renal failure is a common complication of cardiac surgery, with oxidants found to play an important role in renal injury. We therefore assessed whether the supplemental antioxidant vitamin E and the inhibitor of xanthine oxidase allopurinol could prevent renal dysfunction after coronary artery bypass graft (CABG) surgery.Methods:Of 60 patients with glomerular filtration rate (GFR) < 60 mL/min scheduled to undergo CABG surgery, 30 were randomized to treatment with vitamin E and allopurinol for 3–5 days before surgery and 30 to no treatment. Serum creatinine levels and potassium and creatinine clearances were measured preoperatively and daily until day 5 after surgery.Results:The patients consisted of 31 males and 29 females, with a mean age of 63 ± 9 years. After surgery, there were no significant differences in mean serum creatinine (1.2 ± 0.33 vs 1.2 ± 0.4 mg/dL; p = 0.43) concentrations, or creatinine clearance (52 ± 12.8 vs 52 ± 12.8 mL/min; p = 0.9). The frequency of acute renal failure did not differ in treatment group compared with control (16% vs 13%; p = 0.5). Length of stay in the intensive care unit (ICU) was significantly longer in the control than in the treated group (3.9 ± 1.5 vs 2.6 ± 0.7 days; p < 0.001).Conclusion:Prophylactic treatment with vitamin E and allopurinol had no renoprotective effects in patients with pre-existing renal failure undergoing CABG surgery. Treatment with these agents, however, reduces the duration of ICU stay.

Strategies for prevention of acute kidney injury in cardiac surgery: an integrative review

“…All studies were published between 1999 and 2013. Three studies were conducted in England, ( 14 - 16 ) two in Australia, ( 17 , 18 ) two in South Korea, ( 19 , 20 ) two in Iran, ( 21 , 22 ) two in Italy, ( 23 , 24 ) one in Austria, ( 25 ) one in the United States, ( 26 ) one in Finland, ( 27 ) one in Greece, ( 28 ) and one in Turkey. ( 29 )…”

Uric Acid and Acute Kidney Injury in the Critically Ill

“…46 Two small studies tested whether lowering plasma uric acid levels may be beneficial in reducing the risk for AKI after cardiac surgery and found no benefit when treated with preoperative allopurinol plus vitamin E or rasburicase (recombinant uricase), respectively. 47,48 We acknowledge that this study has several limitations. The single-center recruitment in the ICU cohort, heterogeneity of ICU patients, and lack of racial diversity in both cohorts limit the generalizability of the study results to all critically ill patients.…”

“… 46 Two small studies tested whether lowering plasma uric acid levels may be beneficial in reducing the risk for AKI after cardiac surgery and found no benefit when treated with preoperative allopurinol plus vitamin E or rasburicase (recombinant uricase), respectively. 47 , 48 …”

Perioperative Acute Kidney Injury

“…The antioxidative benefit of allopurinol and supplements such as selenium, zinc, and vitamins C, E, and B1 have also failed to show benefit in clinical trials. 113,114 Current evidence does not support the role of N-acetylcysteine or supplements such as selenium, zinc, and vitamins C, E, and B1 to prevent acute kidney injury. 111,[113][114][115] The lipid-lowering 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors or statins are a drug class with increasing research interest because of their potential antiinflammatory, antioxidative, and endothelial protective properties.…”

“…113,114 Current evidence does not support the role of N-acetylcysteine or supplements such as selenium, zinc, and vitamins C, E, and B1 to prevent acute kidney injury. 111,[113][114][115] The lipid-lowering 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors or statins are a drug class with increasing research interest because of their potential antiinflammatory, antioxidative, and endothelial protective properties. 29,116,117 A 2018 study involving eight randomized controlled trials investigated the effect of cardiac surgery-associated acute kidney injury and perioperative statin therapy but did not find a correlation between statin administration and acute kidney injury reduction (relative risk 1.17; 95% CI, 0.98 to 1.39; P = 0.076).…”