Aims: Acute kidney injury (AKI) is a common complication following cardiac surgery. Cardiopulmonary bypass elicits coagulation and inflammation activation and oxidative stress, all involved in AKI but never simultaneously assessed. We aimed to evaluate relations between oxidative stress, inflammatory and coagulation systems activation and postoperative renal function in patients with normal preoperative renal function.
Methods: Forty-one high-risk patients (EuroSCORE >6 and preoperative haemoglobin <12 g/dl in women and <13 g/dl in men) were prospectively enrolled. Prothrombin fragment 1.2 (coagulation marker), interleukin-6 and interleukin-10 (pro/anti-inflammatory markers) and 8-oxo-2′-deoxyguanosine (oxidative stress marker) were evaluated until postoperative day 5.
Results: Patients were divided into two groups according to estimated glomerular filtration rate reduction observed postoperatively (reduction <25% in 26 patients: NO-AKI group; reduction >25% in 15 patients: AKI group). No differences were found for inflammatory markers. Oxidative stress slightly increased in the AKI group. Twenty-four hours after the operation prothrombin fragment 1.2 levels were significantly higher in the AKI group (506.6 ± 548 vs. 999 ± 704.1 pmol/l; P = 0.018), and they were independently associated with estimated glomerular filtration rate reduction, with an area under the receiving operating characteristic of 0.744.
Conclusion: Thrombin generation is higher in patients with renal function worsening, and it is an independent risk factor for AKI in patients with anaemia, possibly leading to microcirculation impairment and tubular cells damage.
aDivision of Cardiac Surgery, Department of Emergency and Organs Transplant, University of Bari ‘Aldo Moro’, Bari
bDivision of Cardiac Surgery, ‘Vito Fazzi’ Hospital, Lecce
cDivision of Nephrology, Dialysis and Transplantation, Department of Emergency and Organs Transplant, University of Bari ‘Aldo Moro’, Bari, Italy
Correspondence to Domenico Paparella, MD, Division of Cardiac Surgery, Department of Emergency and Organs Transplant, University of Bari ‘Aldo Moro’, Piazza Giulio Cesare 11, 70100 Bari, Italy Tel: +390805595075; e-mail: firstname.lastname@example.org
Received 7 May, 2015
Revised 4 August, 2015
Accepted 28 October, 2015