Low‐dose vasopressin increases glomerular filtration rate, but impairs renal oxygenation in post‐cardiac surgery patients

Bragadottir, Gudrun; Redfors, Bengt; Nygren, Andreas; Sellgren, Johan; Se, Ricksten

doi:10.1111/j.1399-6576.2009.02037.x

Cited by 72 publications

(80 citation statements)

References 39 publications

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“…This is caused by a considerable elevation of renal vascular resistance and reduction in RBF and renal oxygen delivery 23, 24. We repeatedly found a close positive correlation among GFR, tubular reabsorption, and renal oxygen consumption (RVO 2 ) in patients with normal renal function 23, 25, 26, 27. We had thus expected that our HF patients, because of low GFR levels, would display reduced RVO 2 but found instead that their RVO 2 levels were close to normal 23, 24.…”

Section: Discussionmentioning

confidence: 90%

Differential Effects of Levosimendan and Dobutamine on Glomerular Filtration Rate in Patients With Heart Failure and Renal Impairment:A Randomized Double‐Blind Controlled Trial

Lannemyr

Ricksten

Rundqvist

et al. 2018

JAHA

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BackgroundThe management of the cardiorenal syndrome in advanced heart failure is challenging, and the role of inotropic drugs has not been fully defined. Our aim was to compare the renal effects of levosimendan versus dobutamine in patients with heart failure and renal impairment.Methods and ResultsIn a randomized double‐blind study, we assigned patients with chronic heart failure (left ventricular ejection fraction <40%) and impaired renal function (glomerular filtration rate <80 mL/min per 1.73 m2) to receive either levosimendan (loading dose 12 μg/kg+0.1 μg/kg per minute) or dobutamine (7.5 μg/kg per minute) for 75 minutes. A pulmonary artery catheter was used for measurements of systemic hemodynamics, and a renal vein catheter was used to measure renal plasma flow by the infusion clearance technique for PAH (para‐aminohippurate) corrected by renal extraction of PAH. Filtration fraction was measured by renal extraction of chromium ethylenediamine tetraacetic acid. A total of 32 patients completed the study. Following treatment, the levosimendan and dobutamine groups displayed similar increases in renal blood flow (22% and 26%, respectively) with no significant differences between groups. Glomerular filtration rate increased by 22% in the levosimendan group but remained unchanged in the dobutamine group (P=0.012). Filtration fraction was not affected by levosimendan but decreased by 17% with dobutamine (P=0.045).ConclusionsIn patients with chronic heart failure and renal impairment, levosimendan increases glomerular filtration rate to a greater extent than dobutamine and thus may be the preferred inotropic agent for treating patients with the cardiorenal syndrome.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT02133105.

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Section: Discussionmentioning

confidence: 90%

Differential Effects of Levosimendan and Dobutamine on Glomerular Filtration Rate in Patients With Heart Failure and Renal Impairment:A Randomized Double‐Blind Controlled Trial

Lannemyr

Ricksten

Rundqvist

et al. 2018

JAHA

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“…Vasopressin impairs the renal oxy gen demand/ supply relationship as refl ect ed by the increa se in RO 2 Ex. From [7] with permission.…”

Section: Resultsmentioning

confidence: 99%

“…Tubular transport processes are highly load-dependent and it has been shown in experimental studies [4] and in p atients [2,[5][6][7] that the re i s a close linear correlation between glomerular fi ltration rate (GFR), renal sodium reabsorption and renal VO 2 (Fig. 1).…”

Section: Determin a Nts Of Renal Oxygenationmentioning

confidence: 99%

“…However, because of the close association between GFR, tubular sodium reabsorption and renal VO 2 in humans [5][6][7], a pharmacologically-induced increase in GFR will increase renal VO 2 an d po tentially further impair renal oxygenation in patients with AKI. Th us, an ideal agent to treat ischemic AKI would be one that increases both renal blood fl ow and GFR, i. e., an agent that preferentially induces vasodilation of the preglomerular resistance vessels.…”

Section: Treatment Of Clinical Ischemic Akimentioning

confidence: 99%

“…Bragadottir et al evaluated the renal eff ects of lowdoses (1.2, 2.4, 4.8 U/h) of vasopressin in post-cardiac surgery patients, doses that did not aff ect systemic blood pressure [7]. Vasopr essin exerted a dose-dependent increase i n GFR, sod ium reabsorption, renal VO 2 , renal O 2 Ex and renal vascular resistance, whereas renal blood fl ow decreased.…”

Section: Low-dose Vasopressin and Renal Oxygenationmentioning

confidence: 99%

See 2 more Smart Citations

Renal Oxygenation in Clinical Acute Kidney Injury

Ricksten¹,

Bragadottir²,

Redfors³

2013

Annual Update in Intensive Care and Emergency Medicine 2013

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Renal oxygenation is defi ned as the relationship between renal oxygen delivery (DO 2 ) and renal oxygen consumption (VO 2 ) and it can easily be shown that the inverse of this relationship is equivalent to renal extraction of O 2 (O 2 Ex). An increase in renal O 2 Ex means that renal DO 2 has decreased in relation to renal VO 2 , i. e., renal oxygenation is impaired, and vice versa. When compared to other major organs, renal VO 2 is relatively high, second only to the heart. In sedated, mechanically ventilated patients, renal VO 2 is two-thirds (10 ml/min) that of myocardial oxygen consumption (15 ml/min) (Table 1) [1,2]. Renal blo od fl ow, w hich accounts for approximately 20 % of cardiac output, is three times higher than myocardial blood fl ow in this group of patients. Renal O 2 Ex in the non-failing kidney is therefore low, 10 %, compared with, e.g., the heart, in which O 2 E X is 55 % (Table 1). Determin a nts of renal oxygenationIt is well known from experimental studies that tubular sodium reabsorption is the major determinant of renal VO 2 [3] and tha t under normal physiological conditions, approximately 80 % is used to drive active tubular transport of particularly sodium, but also glucose, amino acids and other solutes. Tubular transport processes are highly load-dependent and it has been shown in experimental studies [4] and in p atients [2,[5][6][7] that the re i s a close linear correlation between glomerular fi ltration rate (GFR), renal sodium reabsorption and renal VO 2 (Fig. 1). Th e fi l tered load of sodium is, thus, an important determi nant of renal VO 2 and maneuvers that decrease GFR and the tubular sodium load act to decrease tubular sodium reabsorption and renal VO 2 , and vice versa [8]. It has b een shown that renal O 2 Ex remains stable over a wide range of renal blood fl ows, which means that changes in renal DO 2 , caused by changes in renal blood fl ow, are directly off set by changes in renal VO 2 [9], i. e., r enal VO 2 is fl ow-dependent. Th us, unlike other organs where increases in blood fl ow will improve oxygenation, increased renal blood fl ow augments GFR and the fi ltered load of sodium, which will increase renal VO 2 . Due to this fl ow-dependency of renal VO 2 , renal oxygenation will re main constant, as long as renal blood fl ow and GFR change in parallel. Regional intrarenal oxygenation and medullary hypoxiaTh e relatively high renal blood fl ow is directed preferentially to the cortex to optimize the fi ltration process and solute reabsorption. In contrast, blood fl ow in the outer medulla is less than 50 % of the cortical blood fl ow to preserve osmotic gradients and to enhance urinary concentration [10]. Th e combi nation of low me dullary perfusion, high oxygen consumption of the medullary thick ascending limbs (mTAL) and the countercurrent exchange of oxygen within the vasa recta, results in a poorly oxygenated outer medulla [11]. Oxygen av ailability is, therefore, low in the outer medulla, which has an oxygen tissue partial pressure (PO 2 ) of 10-20 mm Hg ...

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Cardiovascular Management

2020

Manual of Perioperative Care in Adult Cardiac Surgery

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Low‐dose vasopressin increases glomerular filtration rate, but impairs renal oxygenation in post‐cardiac surgery patients

Cited by 72 publications

References 39 publications

Differential Effects of Levosimendan and Dobutamine on Glomerular Filtration Rate in Patients With Heart Failure and Renal Impairment:A Randomized Double‐Blind Controlled Trial

Differential Effects of Levosimendan and Dobutamine on Glomerular Filtration Rate in Patients With Heart Failure and Renal Impairment:A Randomized Double‐Blind Controlled Trial

Renal Oxygenation in Clinical Acute Kidney Injury

Cardiovascular Management

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