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

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 cardio...

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Bibliographic Details
Published in:Clinical and experimental pharmacology & physiology 2020-04, Vol.47 (4), p.640-649
Main Authors: Feirer, Nina, Dieterlen, Maja‐Theresa, Klaeske, Kristin, Kiefer, Philipp, Oßmann, Susann, Salameh, Aida, Borger, Michael A., Hoyer, Alexandro
Format: Article
Language:English
Subjects:
acute kidney injury
Animal models
Apoptosis
Biomarkers
Calcium
Calcium (blood)
cardioplegia
cardiopulmonary bypass
Custodiol
Custodiol‐N
Cytochrome
Cytochrome c
Cytochromes
Heart surgery
Hemoglobin
Histidine
Ketoglutaric acid
Kidneys
Reperfusion
Statistics
Swelling
Swine
Tryptophan
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Summary: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 
ISSN:0305-1870
1440-1681
DOI:10.1111/1440-1681.13236