Wider intraoperative glycemic fluctuation increases risk of acute kidney injury after pediatric cardiac surgery

Hu, Guo‐Huang; Duan, Lian; Jiang, Meng; Zhang, Chengliang; Duan, Yanying

doi:10.1080/0886022x.2018.1532908

Cited by 7 publications

(7 citation statements)

References 32 publications

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“…Since double knockout of TLR2 and 4 did not provide additional benefits against renal IRI compared with deletion of either TLR2 or TLR4 alone [29], the renoprotective effect of TIP1 could be derived from the predominant effect on TLR4. Or our result may reflect the net effect of TIP1 on multiple TLRs since other TLRs, such as TLR3 and 9, have been reported to mediate injury in kidneys subject to IRI [8,9].…”

Section: Discussionmentioning

confidence: 86%

“…The binding of TLR with danger signals prompts a downstream signaling cascade that results in the production of proinflammatory cytokines and chemokines, which then promotes the influx of leukocytes in the post-ischemic tissues. In knockout mouse models with genetic depletion of TLR2, 3, 4, and 9, the kidneys were more protected from IRI as demonstrated by diminished tubular injury and lower inflammatory cell infiltration than those in wild-type mice [4,[6][7][8][9]. In humans, donor kidneys expressing mutated TLR4 (weaker affinity for HMGB1) had fewer inflammatory cytokines and a lower rate of delayed graft function than those expressing wild-type TLR4 [10].…”

Section: Introductionmentioning

confidence: 99%

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A Cell-Penetrating Peptide That Blocks Toll-Like Receptor Signaling Protects Kidneys against Ischemia-Reperfusion Injury

Jung

Seo

Park

et al. 2021

IJMS

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Renal ischemia-reperfusion injury (IRI) is involved in the majority of clinical conditions that manifest as renal function deterioration; however, specific treatment for this type of injury is still far from clinical use. Since Toll-like receptor (TLR)-mediated signaling is a key mediator of IRI, we examined the effect of a multiple-TLR-blocking peptide named TLR-inhibitory peptide 1 (TIP1), which exerts the strongest action on TLR4, on renal IRI. We subjected C57BL/6 mice to 23 min of renal pedicle clamping preceded by intraperitoneal injection with a vehicle or TIP1. Sham control mice underwent flank incision only. Mouse kidneys were harvested after 24 h of reperfusion for histology, western blot, RT-PCR, and flow cytometry analysis. Pretreatment with TIP1 lowered the magnitude of elevated plasma creatinine levels and attenuated tubular injury. TIP1 treatment also reduced mRNA expression of inflammatory cytokines and decreased apoptotic cells and oxidative stress in post-ischemic kidneys. In kidneys pretreated with TIP1, the infiltration of macrophages and T helper 17 cells was less abundant than those in the IRI only group. These results suggest that TIP1 has a potential beneficial effect in attenuating the degree of kidney damage induced by IRI.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

A Cell-Penetrating Peptide That Blocks Toll-Like Receptor Signaling Protects Kidneys against Ischemia-Reperfusion Injury

Jung

Seo

Park

et al. 2021

IJMS

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“…Inotropic administration was defined as the use of dopamine, dobutamine, noradrenaline, or adrenaline (µg/kg/min) for at least 1 h during the first 24 h postoperatively. Postoperative morbidity included multiple organ dysfunction syndrome, low cardiac output [13], central nervous system (CNS) injury [14], acute kidney injury [15], acute hepatic injury [16], systemic infection, pleural effusion/pneumothorax requiring closed-chest drainage, delayed incision healing, and 30-day mortality (including patients who died 30 days postoperatively but were not discharged).…”

Section: Methodsmentioning

confidence: 99%

Hemoadsorption and Coagulation Systemic Rebalance in Patients Undergoing Nonelective Cardiac Surgery and Treated with Antithrombotics

Li,

Duan,

Wang

et al. 2024

Blood Purif

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Introduction: Insufficient withdrawal duration of antithrombotics leads to excessive bleeding after major surgery. We hypothesize that intraoperative hemoadsorption (HA) can reduce postoperative allogeneic transfusion requirements and excessive bleeding events (EBE), without an increase in ischemic/thromboembolic events (ITE) in patients who have taken antithrombotics and undergone nonelective cardiac surgery. Methods: A total of 460 patients admitted to our hospital from 2018 to 2022 were included in this study and divided into two groups: HA and non-HA. Because of the risk of bias due to differences in antithrombotic type, withdrawal duration or basic coagulation function, propensity score matching was used for analyses. Results: Out of 154 cases in the HA group, 144 pairs were successfully matched. No HA safety events such as hemolysis, hypotension or device failure occurred. After matching, the two groups were found to be comparable in preoperative antithrombotic type, withdrawal duration, platelets and coagulation function, and demographic and perioperative characteristics. Although the HA group did not have a reduced incidence of EBE, this group exhibited significant decreases in the transfusion rate and volume, the incidence of ITE, acute kidney injury and central nervous system injury. Conclusions: For patients who undergone nonelective cardiac surgery and taken antithrombotics, HA can simply and safely rebalance of postoperative coagulation system, have associations with reduced transfusion and postoperative ITE.

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“…Concerning pediatric patients having cardiac surgery, especially with CPB, they are prone to varieties of blood glucose levels intraoperatively. Unexpectedly, studies as to the harm from intraoperative blood glucose levels or glucose variability are inconclusive [9][10][11][12]. Meanwhile, tight blood glucose control might not be beneficial to a decreased incidence of AKI [13].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Blood Glucose Levels and Postoperative Acute Kidney Injury in Pediatric Patients Having Congenital Heart Surgery under Cardiopulmonary Bypass

Bie,

Wang,

Zhang

et al. 2023

Congenital Heart Disease

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Purpose: This study sought to explore the effect of intraoperative mean blood glucose levels and variability on postoperative acute kidney injury (AKI) in children undergoing congenital cardiac surgery. Methods: We conducted a prospective nested case-control study in children (age < 18 years) undergoing congenital heart surgery with cardiopulmonary bypass (CPB) at the Fuwai Hospital between April 01, 2022 and July 30, 2022. Cases were individuals who developed AKI within the first postoperative 7 days (AKI group) and controls were those without AKI (Non-AKI group) according to KDIGO criteria. AKI and Non-AKI groups unmatched and 1:1 matched by age, sex, and baseline serum creatinine were separately analyzed. Multivariate logistic and conditional logistic regressions were used to assess the associations between blood glucose variables and AKI. Results: 688 consecutively approached patients were included in the final analysis. On multivariate analysis, intra-CPB (adjusted odds ratio [OR] 0.802; 95% confidence interval [CI], 0.706 to 0.912; p = 0.001) and post-CPB (adjusted OR 0.830; 95% CI, 0.744 to 0.925; p = 0.001) blood glucose levels were associated with postoperative AKI. There were no significant differences in pre-CPB blood glucose (adjusted OR 0.926; 95% CI, 0.759 to 1.129; p = 0.446) or intraoperative glycemic fluctuations (adjusted OR 0.905; 95% CI, 0.723 to 1.132; p = 0.382) between AKI and Non-AKI groups. Results based on matched cases and controls were consistent with those from the unmatched analyses. Conclusion: Higher intraoperative blood glucose levels during and after CPB were protective factors against postoperative AKI in pediatric patients after congenital heart surgery.

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Wider intraoperative glycemic fluctuation increases risk of acute kidney injury after pediatric cardiac surgery

Cited by 7 publications

References 32 publications

A Cell-Penetrating Peptide That Blocks Toll-Like Receptor Signaling Protects Kidneys against Ischemia-Reperfusion Injury

A Cell-Penetrating Peptide That Blocks Toll-Like Receptor Signaling Protects Kidneys against Ischemia-Reperfusion Injury

Hemoadsorption and Coagulation Systemic Rebalance in Patients Undergoing Nonelective Cardiac Surgery and Treated with Antithrombotics

Intraoperative Blood Glucose Levels and Postoperative Acute Kidney Injury in Pediatric Patients Having Congenital Heart Surgery under Cardiopulmonary Bypass

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