Kidney-Specific Proteins in Elderly Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass: Retracted

Boldt, Joachim; Brenner, Torsten; Lang, Johannes; Kumle, Bernhard; Isgro, Frank

doi:10.1213/01.ane.0000090146.02929.2e

Cited by 48 publications

(40 citation statements)

References 28 publications

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“…The clinical importance of elevated levels of KIM-1, NAG, and NGAL during the postoperative period remains uncertain in the non-AKI group. Subclinical alterations in renal function detected by urinary biomarkers have been reported previously without overt changes in Scr (35)(36)(37). Because there was no pathologic evaluation of the kidney we cannot relate the biomarkers to injury directly.…”

Section: Discussionmentioning

confidence: 85%

Urinary Biomarkers in the Early Detection of Acute Kidney Injury after Cardiac Surgery

Han¹,

Wagener²,

Zhu³

et al. 2009

Clinical Journal of the American Society of Nephrology

353

249

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Section: Discussionmentioning

confidence: 85%

Urinary Biomarkers in the Early Detection of Acute Kidney Injury after Cardiac Surgery

Han¹,

Wagener²,

Zhu³

et al. 2009

Clinical Journal of the American Society of Nephrology

353

249

View full text Add to dashboard Cite

show abstract

“…The clinical significance of this primary outcome is not clear. 37 Of note, N-acetylcysteine was also associated with a non-significantly lower risk of a 44 µmol·L -1 or 25% increase in creatinine concentration (42.1% vs 48.7%).…”

Section: Continuous Outcomes Difference || 95% CI Pmentioning

confidence: 89%

N-acetylcysteine for preventing acute kidney injury in cardiac surgery patients with pre-existing moderate renal insufficiency

Wijeysundera

Beattie

Rao

et al. 2007

Can J Anesth/J Can Anesth

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Purpose: N-acetylcysteine may prevent acute kidney injury after cardiac surgery. To determine if N-acetylcysteine warrants definitive evaluation in a large multicentre trial, we evaluated its effects on a surrogate outcome, estimated glomerular filtration rate (eGFR), in a randomized trial. Methods:One-hundred-seventy-seven cardiac surgery patients with moderate pre-existing renal insufficiency (eGFR ≤ 60 mL·min -1 ) were recruited in a blinded (patients, clinicians, datacollectors) placebo-controlled randomized trial. Eighty-nine were randomized to N-acetylcysteine (100 mg·kg -1 iv bolus, 20 mg·kg -1 ·hr -1 infusion until four hours after cardiopulmonary bypass), and 88 to placebo. The primary outcome was the percent change in eGFR during the first 72 postoperative hours. Secondary outcomes included renal replacement therapy, mortality, atrial fibrillation, vasoactive medications, and adverse effects. A future multicentre trial was deemed to be warranted if N-acetylcysteine was associated with a percent change in eGFR that was 3.8 better (small benefit), and with an upper 95% confidence interval including 9.5 (moderate benefit). Results: The median percent change in eGFR was 5.2% better (absolute difference) in the N-acetylcysteine arm (95% confidence interval 2.4% worse to 12.1% better; P = 0.22). With regard to secondary outcomes, all-cause mortality was lower in the N-acetylcysteine arm (0% vs 8%; P = 0.007). Conclusion:N-acetylcysteine did not cause a statistically significant improvement in postoperative eGFR in this singlecentre study. Nonetheless, its treatment effect was consistent with a plausible small-to-moderate benefit. Given this finding, N-acetylcysteine should be definitively evaluated in a large randomized trial.

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“…However, another study found that the rise in urinary NAG is extremely sensitive to renal tubular injury and increases also in patients who do not develop clinical AKI after surgery [32,33]. Similarly, Blaikley et al [34] found RBP to rise significantly 3 h after cardiac surgery in a small study of 7 patients, but did not calculate its predictive value.…”

Section: Discussionmentioning

confidence: 99%

Clinical Usefulness of Novel Biomarkers for the Detection of Acute Kidney Injury following Elective Cardiac Surgery

et al. 2010

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Background/Aims: Acute kidney injury (AKI) is common following cardiac surgery and predicts a poor outcome. However, the early detection of AKI has proved elusive and most cases are diagnosed only following a significant rise in serum creatinine (SCr). We compared a panel of early biomarkers of AKI for the detection of AKI in patients undergoing heart surgery. This study included serum cystatin C (CyC) and urinary levels of neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), retinol-binding protein (RBP) and N-acetyl-β-D-glucosaminidase (NAG). Methods: We retrospectively identified 15 patients undergoing open cardiac surgery who developed AKI within 72 h postoperatively. For these, we identified 15 matched controls also having undergone surgery but without AKI. Serial serum and urine samples had prospectively been postoperatively obtained from all patients at 0, 2, 4, 6, 10, 24, 48 and 72 h after admission to the intensive care unit. AKI was defined as a >50% increase in SCr. CyC was measured by nephelometry, while NGAL, IL-18, and RBP were measured by ELISA and NAG was measured by spectrophotometry. The urinary biomarkers were normalized to urinary creatinine (UCr) concentration. Each marker was assessed at each time point for its predictive value using receiver operating characteristic curves to predict AKI. Results: Following the exclusion of 1 case due to a urinary tract infection, the final cohort consisted of 29 patients aged 62.9 ± 13.7 years with baseline SCr of 73.2 ± 11.9 µmol/l. While there were no differences in the demographics between cases and controls, the aortic clamp time was predictably higher in AKI cases than in controls (60.6 ± 13.9 vs. 43.0 ± 9.2 min, p < 0.05). Each biomarker differed significantly between cases and controls for at least one time point. The optimal area under the curve (AUC) was for CyC at 10 h (sensitivity 0.71, specificity 0.92, cutoff 1.31 mg/l), NGAL at 0 h (sensitivity 0.84, specificity 0.80, cutoff 49.15 µg/g UCr), IL-18 at 2 h (sensitivity 0.85, specificity 0.73, cutoff 285.65 ng/g UCr), RBP at 0 h (sensitivity 0.75, specificity 0.67, cutoff 2,934.65 µg/g UCr) and NAG at 4 h (sensitivity 0.86, specificity 0.67, cutoff 37.05 U/mg UCr). Using a combination of all 5 biomarkers analyzed at the optimal time point as above, we were able to obtain an AUC of 0.98 (0.93–1.02, p < 0.001) in this limited sample. Conclusion: The use of serum and urinary biomarkers for the prediction of AKI in patients undergoing cardiac surgery is highly dependent on the sampling time. Of the evaluated markers urinary NGAL had the best predictive profile. The previously unstudied marker of urinary RBP showed similar predictive power as more established markers. By combining all 5 studied biomarkers we were able to predict significantly more cases, suggesting that the use of more than one marker may be beneficial clinically.

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Kidney-Specific Proteins in Elderly Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass: Retracted

Cited by 48 publications

References 28 publications

Urinary Biomarkers in the Early Detection of Acute Kidney Injury after Cardiac Surgery

Urinary Biomarkers in the Early Detection of Acute Kidney Injury after Cardiac Surgery

N-acetylcysteine for preventing acute kidney injury in cardiac surgery patients with pre-existing moderate renal insufficiency

Clinical Usefulness of Novel Biomarkers for the Detection of Acute Kidney Injury following Elective Cardiac Surgery

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