Exogenous nitric oxide delivery protects against cardiopulmonary bypass–associated acute kidney injury: Histologic and serologic evidence from an ovine model

Greenberg, Jason W.; Hogue, Spencer; Raees, Muhammad; Ahmed, Hosam F.; Abplanalp, William; Guzman-Gomez, Amalia; Abdelhamed, Zakia; Thangappan, Karthik; Reagor, James A.; Rose, James E.; Collins, Michaela; Kasten, Jennifer L; Goldstein, Stuart L.; Zafar, Farhan; Morales, David; Cooper, David S.

doi:10.1016/j.jtcvs.2023.03.030

Cited by 4 publications

(2 citation statements)

References 33 publications

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“…Given the essential role of NO, a clinical study of prolonged CPB (over 90 min) among Chinese patients indicated that administering NO (80 parts per million [ppm]) intraoperatively and on the first postoperative day significantly reduced the incidence of AKI incidence and the incidence of AKI-related AKI [ 218 ]. A similar outcome was observed in another trial in which a lower NO dose (40 ppm) was used [ 219 ]; however, recently, animal investigations have also indicated the positive function of NO in preventing AKI post CPB and provided histologic evidence [ 220 ]. However, a retrospective cohort study of children revealed that 20 ppm of NO during the CPB circuit fails to diminish the incidence of AKI [ 221 ], and treatment with NO might not be suitable for patients with acute respiratory distress syndrome [ 222 ].…”

Section: Medical Therapysupporting

confidence: 63%

Cardiopulmonary bypass associated acute kidney injury: better understanding and better prevention

Yang,

Zhu,

Pan

et al. 2024

Renal Failure

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Cardiopulmonary bypass (CPB) is a common technique in cardiac surgery but is associated with acute kidney injury (AKI), which carries considerable morbidity and mortality. In this review, we explore the range and definition of CPB-associated AKI and discuss the possible impact of different disease recognition methods on research outcomes. Furthermore, we introduce the specialized equipment and procedural intricacies associated with CPB surgeries. Based on recent research, we discuss the potential pathogenesis of AKI that may result from CPB, including compromised perfusion and oxygenation, inflammatory activation, oxidative stress, coagulopathy, hemolysis, and endothelial damage. Finally, we explore current interventions aimed at preventing and attenuating renal impairment related to CPB, and presenting these measures from three perspectives: (1) avoiding CPB to eliminate the fundamental impact on renal function; (2) optimizing CPB by adjusting equipment parameters, optimizing surgical procedures, or using improved materials to mitigate kidney damage; (3) employing pharmacological or interventional measures targeting pathogenic factors.

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Section: Medical Therapysupporting

confidence: 63%

Cardiopulmonary bypass associated acute kidney injury: better understanding and better prevention

Yang,

Zhu,

Pan

et al. 2024

Renal Failure

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“…Our findings have several translationally significant consequences. In a recent experimental study, NO administered with CPB demonstrated serologic and histologic evidence of renal protection from AKI [ 39 ]. The authors demonstrated the histological picture.…”

Section: Discussionmentioning

confidence: 99%

The Nephroprotective Effect of Nitric Oxide during Extracorporeal Circulation: An Experimental Study

Kamenshchikov,

Podoksenov,

Kozlov

et al. 2024

Biomedicines

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This study aims to determine the effectiveness of administering 80 ppm nitric oxide in reducing kidney injury, mitochondrial dysfunction and regulated cell death in kidneys during experimental perfusion. Twenty-four sheep were randomized into four groups: two groups received 80 ppm NO conditioning with 90 min of cardiopulmonary bypass (CPB + NO) or 90 min of CPB and hypothermic circulatory arrest (CPB + CA + NO), while two groups received sham protocols (CPB and CPB + CA). Kidney injury was assessed using laboratory (neutrophil gelatinase-associated lipocalin, an acute kidney injury biomarker) and morphological methods (morphometric histological changes in kidney biopsy specimens). A kidney biopsy was performed 60 min after weaning from mechanical perfusion. NO did not increase the concentrations of inhaled NO2 and methemoglobin significantly. The NO-conditioning groups showed less severe kidney injury and mitochondrial dysfunction, with statistical significance in the CPB + NO group and reduced tumor necrosis factor-α expression as a trigger of apoptosis and necroptosis in renal tissue in the CPB + CA + NO group compared to the CPB + CA group. The severity of mitochondrial dysfunction in renal tissue was insignificantly lower in the NO-conditioning groups. We conclude that NO administration is safe and effective at reducing kidney injury, mitochondrial dysfunction and regulated cell death in kidneys during experimental CPB.

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Commentary: Encouraging findings for the renal-protective effect of nitric oxide administration during cardiopulmonary bypass

Clark

2023

The Journal of Thoracic and Cardiovascular Surgery

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Exogenous nitric oxide delivery protects against cardiopulmonary bypass–associated acute kidney injury: Histologic and serologic evidence from an ovine model

Cited by 4 publications

References 33 publications

Cardiopulmonary bypass associated acute kidney injury: better understanding and better prevention

Cardiopulmonary bypass associated acute kidney injury: better understanding and better prevention

The Nephroprotective Effect of Nitric Oxide during Extracorporeal Circulation: An Experimental Study

Commentary: Encouraging findings for the renal-protective effect of nitric oxide administration during cardiopulmonary bypass

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