Impact of Custodiol-N cardioplegia on acute kidney injury after cardiopulmonary bypass.

Abstract

Myocardial protection during cardiopulmonary bypass (CPB) can be achieved using cardioplegic solutions. Although, acute kidney injury (AKI) is a common complication following CPB, the effects of cardioplegic solutions on AKI have rarely been investigated. Within this study, the effects of the cardioplegic solutions histidine-tryptophan-ketoglutarate (HTK; Custodiol) and HTK-N (Custodiol-N) on AKI in a large animal model were compared. Therefore, Landrace pigs underwent median sternotomy, CPB at 34°C, 90 minutes of cardiac arrest and 120 minutes of reperfusion. Animals were randomized for single-shot cardioplegia with either HTK (n = 10) or HTK-N (n = 10). Renal biopsies and sera were analyzed to determine AKI biomarkers and apoptosis. Compared to HTK, HTK-N induced a decreased extent of proximal tubule swelling (48.3 ± 1.6 µm vs 52.3 ± 1.1 µm, P = .05) and decreased cytochrome c release (0.26 ± 0.04 vs 0.46 ± 0.08, P = .04) without reaching statistical significance due to Bonferroni correction. Comparing baseline and postreperfusion levels, the hemoglobin (Hb) and blood calcium levels were lower in HTK-N (Hbbaseline : 6.0 ± 0.6 mmol/L, Hbreperfusion : 6.2 ± 0.7 mmol/L, P = .12; Ca2+baseline : 1.36 ± 0.05 mmol/L, Ca2+reperfusion : 1.28 ± 0.05 mmol/L, P = .16) compared to the HTK group (Hbbaseline : 5.9 ± 0.4 mmol/L, Hbreperfusion : 4.7 ± 0.8 mmol/L, P < .01; Ca2+baseline : 1.34 ± 0.07 mmol/L, Ca2+reperfusion : 1.24 ± 0.06 mmol/L, P < .01). The present study showed that HTK-N could positively affect the kidney during CPB. Hb and calcium levels were stabilized. A statistical trend was found showing that AKI-related proximal tubule swelling and cytochrome c release were diminished.

• Authors: Nina Feirer, Maja-Theresa Dieterlen, Kristin Klaeske, Philipp Kiefer, Susann Oßmann, Aida Salameh, Michael A Borger, Alexandro Hoyer
• Journal: Clinical and experimental pharmacology & physiology (Clin Exp Pharmacol Physiol) Vol. 47 Issue 4 Pg. 640-649 (04 2020) ISSN: 1440-1681 [Electronic] Australia
• PMID: 31869857 (Publication Type: Journal Article)
• Copyright: © 2019 John Wiley & Sons Australia, Ltd.

Chemical References

• Custodiol-N solution
• Hemoglobins
• Organ Preservation Solutions
• Cytochromes c
• Calcium

Topics

• Acute Kidney Injury (blood, etiology, metabolism, prevention & control)
• Animals
• Calcium (blood)
• Cardiopulmonary Bypass (adverse effects)
• Cytochromes c (metabolism)
• Heart Arrest, Induced
• Hemoglobins (metabolism)
• Male
• Organ Preservation Solutions (pharmacology)
• Swine
• Time Factors