Comparison of renal perfusion solutions during thoracoabdominal aortic aneurysm repair

Yamume Tshomba, Andrea Kahlberg, Germano Melissano, Giovanni Coppi, Enrico Marone, Denise Ferrari, Rosalba Lembo, Roberto Chiesa

Risultato della ricerca: Contributo in rivistaArticolo in rivista

40 Citazioni (Scopus)

Abstract

Background To determine whether renal perfusion with cold crystalloid solution enriched with histidine-tryptophan-ketoglutarate (Custodiol; Dr Franz-Kohler Chemie GmbH, Bensheim, Germany) provides better protection against renal ischemic injury than cold lactated Ringer's solution in patients undergoing thoracoabdominal aortic aneurysm open repair. Methods We analyzed a prospectively compiled database containing all 111 consecutive patients who underwent thoracoabdominal aortic aneurysm open repair at our center from 2008 to 2011. A cohort of 104 consecutive patients was identified of which 50 (48%) had renal perfusion with Custodiol and 54 (52%) with lactated Ringer's solution. Propensity score matching based on baseline clinical variables, which were expected to influence renal outcomes, was performed to correct for any bias that may have been associated with the use of Custodiol. Acute kidney injury (AKI) as defined by Kidney Disease Improving Global Outcomes guidelines and perioperative estimated glomerular filtration rate were compared in the two groups. Independent predictors of AKI were also identified by multivariate analysis. Results After propensity score matching, we were able to match 42 Custodiol cases one-to-one with those receiving perfusion with lactated Ringer's solution. Overall 30-day mortality was 5.9%; temporary hemodialysis or continuous veno-venous hemofiltration was needed in 4.8% of the patients without any case of dialysis at discharge. Freedom from AKI was significantly increased in the Custodiol group (38.1% vs 9.5%; P =.002) despite longer total renal ischemic time (51.5 ± 16.4 minutes vs 43.6 ± 16.0 minutes; P =.05). By analysis of variance for repeated measures, a significant upward trend of perioperative estimated glomerular filtration rate was observed in the Custodiol group (group × time interaction = F3,66; P <.001), and by multivariate analysis, Custodiol perfusion was the only independent predictor of non-AKI (P =.04). Conclusions The use of Custodiol was safe and provided improved perioperative renal function compared with lactated Ringer's solution. Randomized trials are needed to confirm these data and to assess their clinical consequences. © 2014 by the Society for Vascular Surgery.
Lingua originaleEnglish
pagine (da-a)623-633
Numero di pagine11
RivistaJournal of Vascular Surgery
Volume59
DOI
Stato di pubblicazionePubblicato - 2014

Keywords

  • Acute Kidney Injury
  • Aged
  • Aortic Aneurysm, Thoracic
  • Cardiology and Cardiovascular Medicine
  • Cold Temperature
  • Female
  • Glomerular Filtration Rate
  • Glucose
  • Humans
  • Isotonic Solutions
  • Italy
  • Kaplan-Meier Estimate
  • Kidney
  • Linear Models
  • Logistic Models
  • Male
  • Mannitol
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Perfusion
  • Potassium Chloride
  • Prevalence
  • Procaine
  • Propensity Score
  • Renal Dialysis
  • Reperfusion Injury
  • Retrospective Studies
  • Risk Factors
  • Surgery
  • Time Factors
  • Treatment Outcome
  • Vascular Surgical Procedures

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