Hemolysis is associated with acute kidney injury during major aortic surgery.

I.C. Vermeulen Windsant, M.G. Snoeijs, S.J.P. Hanssen, S. Altintas, J.H. Heijmans, T.A. Koeppel, G.W.H. Schurink, W.A. Buurman, M.J.H.M. Jacobs

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63 Citations (Scopus)

Abstract

Hemolysis is an inevitable side effect of cardiopulmonary bypass resulting in increased plasma free hemoglobin that may impair tissue perfusion by scavenging nitric oxide. Acute kidney injury after on-pump cardiovascular surgery arises from a number of causes and severely affects patient morbidity and mortality. Here, we studied the effect of acute hemolysis on renal injury in 35 patients undergoing on-pump surgical repair of thoracic and thoracoabdominal aortic aneurysms of whom 19 experienced acute kidney injury. During surgery, plasma free hemoglobin increased, as did urinary excretion of the tubular injury marker N-acetyl-beta-D-glucosaminidase, in patients with and without acute kidney injury, reaching peak levels at 2 h and 15 min, respectively, after reperfusion. Furthermore, plasma free hemoglobin was independently and significantly correlated with the urine biomarker, which, in turn, was independently and significantly associated with the later postoperative increase in serum creatinine. Importantly, peak plasma free hemoglobin and urine N-acetyl-beta-D-glucosaminidase concentrations had significant predictive value for postoperative acute kidney injury. Thus, we found an association between increased plasma free hemoglobin and renal injury casting new light on the pathophysiology of acute kidney injury. Therefore, free hemoglobin is a new therapeutic target to improve clinical outcome after on-pump cardiovascular surgery.Kidney International advance online publication, 24 February 2010; doi:10.1038/ki.2010.24.
Original languageEnglish
Pages (from-to)913-920
Number of pages8
JournalKidney International
Volume77
Issue number10
DOIs
Publication statusPublished - May 2010

Keywords

  • acute kidney injury
  • cardiovascular
  • nitric oxide
  • renal proximal tubule cell
  • risk factors
  • ACUTE-RENAL-FAILURE
  • SICKLE-CELL-DISEASE
  • NITRIC-OXIDE BIOAVAILABILITY
  • CARDIOPULMONARY BYPASS
  • CARDIAC-SURGERY
  • FREE HEMOGLOBIN
  • ENDOTHELIAL DYSFUNCTION
  • PULMONARY-HYPERTENSION
  • STRATIFICATION
  • INFLAMMATION

Cite this

Vermeulen Windsant, I.C. ; Snoeijs, M.G. ; Hanssen, S.J.P. ; Altintas, S. ; Heijmans, J.H. ; Koeppel, T.A. ; Schurink, G.W.H. ; Buurman, W.A. ; Jacobs, M.J.H.M. / Hemolysis is associated with acute kidney injury during major aortic surgery. In: Kidney International. 2010 ; Vol. 77, No. 10. pp. 913-920.
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abstract = "Hemolysis is an inevitable side effect of cardiopulmonary bypass resulting in increased plasma free hemoglobin that may impair tissue perfusion by scavenging nitric oxide. Acute kidney injury after on-pump cardiovascular surgery arises from a number of causes and severely affects patient morbidity and mortality. Here, we studied the effect of acute hemolysis on renal injury in 35 patients undergoing on-pump surgical repair of thoracic and thoracoabdominal aortic aneurysms of whom 19 experienced acute kidney injury. During surgery, plasma free hemoglobin increased, as did urinary excretion of the tubular injury marker N-acetyl-beta-D-glucosaminidase, in patients with and without acute kidney injury, reaching peak levels at 2 h and 15 min, respectively, after reperfusion. Furthermore, plasma free hemoglobin was independently and significantly correlated with the urine biomarker, which, in turn, was independently and significantly associated with the later postoperative increase in serum creatinine. Importantly, peak plasma free hemoglobin and urine N-acetyl-beta-D-glucosaminidase concentrations had significant predictive value for postoperative acute kidney injury. Thus, we found an association between increased plasma free hemoglobin and renal injury casting new light on the pathophysiology of acute kidney injury. Therefore, free hemoglobin is a new therapeutic target to improve clinical outcome after on-pump cardiovascular surgery.Kidney International advance online publication, 24 February 2010; doi:10.1038/ki.2010.24.",
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Hemolysis is associated with acute kidney injury during major aortic surgery. / Vermeulen Windsant, I.C.; Snoeijs, M.G.; Hanssen, S.J.P.; Altintas, S.; Heijmans, J.H.; Koeppel, T.A.; Schurink, G.W.H.; Buurman, W.A.; Jacobs, M.J.H.M.

In: Kidney International, Vol. 77, No. 10, 05.2010, p. 913-920.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - Hemolysis is associated with acute kidney injury during major aortic surgery.

AU - Vermeulen Windsant, I.C.

AU - Snoeijs, M.G.

AU - Hanssen, S.J.P.

AU - Altintas, S.

AU - Heijmans, J.H.

AU - Koeppel, T.A.

AU - Schurink, G.W.H.

AU - Buurman, W.A.

AU - Jacobs, M.J.H.M.

PY - 2010/5

Y1 - 2010/5

N2 - Hemolysis is an inevitable side effect of cardiopulmonary bypass resulting in increased plasma free hemoglobin that may impair tissue perfusion by scavenging nitric oxide. Acute kidney injury after on-pump cardiovascular surgery arises from a number of causes and severely affects patient morbidity and mortality. Here, we studied the effect of acute hemolysis on renal injury in 35 patients undergoing on-pump surgical repair of thoracic and thoracoabdominal aortic aneurysms of whom 19 experienced acute kidney injury. During surgery, plasma free hemoglobin increased, as did urinary excretion of the tubular injury marker N-acetyl-beta-D-glucosaminidase, in patients with and without acute kidney injury, reaching peak levels at 2 h and 15 min, respectively, after reperfusion. Furthermore, plasma free hemoglobin was independently and significantly correlated with the urine biomarker, which, in turn, was independently and significantly associated with the later postoperative increase in serum creatinine. Importantly, peak plasma free hemoglobin and urine N-acetyl-beta-D-glucosaminidase concentrations had significant predictive value for postoperative acute kidney injury. Thus, we found an association between increased plasma free hemoglobin and renal injury casting new light on the pathophysiology of acute kidney injury. Therefore, free hemoglobin is a new therapeutic target to improve clinical outcome after on-pump cardiovascular surgery.Kidney International advance online publication, 24 February 2010; doi:10.1038/ki.2010.24.

AB - Hemolysis is an inevitable side effect of cardiopulmonary bypass resulting in increased plasma free hemoglobin that may impair tissue perfusion by scavenging nitric oxide. Acute kidney injury after on-pump cardiovascular surgery arises from a number of causes and severely affects patient morbidity and mortality. Here, we studied the effect of acute hemolysis on renal injury in 35 patients undergoing on-pump surgical repair of thoracic and thoracoabdominal aortic aneurysms of whom 19 experienced acute kidney injury. During surgery, plasma free hemoglobin increased, as did urinary excretion of the tubular injury marker N-acetyl-beta-D-glucosaminidase, in patients with and without acute kidney injury, reaching peak levels at 2 h and 15 min, respectively, after reperfusion. Furthermore, plasma free hemoglobin was independently and significantly correlated with the urine biomarker, which, in turn, was independently and significantly associated with the later postoperative increase in serum creatinine. Importantly, peak plasma free hemoglobin and urine N-acetyl-beta-D-glucosaminidase concentrations had significant predictive value for postoperative acute kidney injury. Thus, we found an association between increased plasma free hemoglobin and renal injury casting new light on the pathophysiology of acute kidney injury. Therefore, free hemoglobin is a new therapeutic target to improve clinical outcome after on-pump cardiovascular surgery.Kidney International advance online publication, 24 February 2010; doi:10.1038/ki.2010.24.

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KW - risk factors

KW - ACUTE-RENAL-FAILURE

KW - SICKLE-CELL-DISEASE

KW - NITRIC-OXIDE BIOAVAILABILITY

KW - CARDIOPULMONARY BYPASS

KW - CARDIAC-SURGERY

KW - FREE HEMOGLOBIN

KW - ENDOTHELIAL DYSFUNCTION

KW - PULMONARY-HYPERTENSION

KW - STRATIFICATION

KW - INFLAMMATION

U2 - 10.1038/ki.2010.24

DO - 10.1038/ki.2010.24

M3 - Article

VL - 77

SP - 913

EP - 920

JO - Kidney International

JF - Kidney International

SN - 0085-2538

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