• J. Cardiothorac. Vasc. Anesth. · Aug 2022

    Is an Acute Perioperative Increase in Creatinine Production Rate a Potential Mechanism for an Early Creatinine-Based Signal of Renal Injury After Cardiac Surgery?

    • David R McIlroy, Darcy Tupper-Creed, Aimee Neylan, Ron Glick, and Benjamin French.
    • Vanderbilt University Medical Center, Nashville, TN; Monash University, Commercial Road, Melbourne, Victoria, Australia. Electronic address: david.r.mcilroy@vumc.org.
    • J. Cardiothorac. Vasc. Anesth. 2022 Aug 1; 36 (8 Pt B): 3114-3123.

    ObjectivesPrevious studies report a creatinine-based signal of injury within hours after cardiac surgery, which is sooner than expected based on creatinine kinetic modelling. A plausible mechanism for such an early signal has not been established, but might be explained by an acute perioperative increase in creatinine production rate (Crprod-rate). The authors sought to test the hypothesis that perioperative Crprod-rate increases from baseline in patients undergoing cardiac surgery.DesignProspective cohort study.SettingAcademic medical center.ParticipantsFifty adult male patients undergoing cardiac surgery.InterventionsNone.Measurements And Main ResultsBased on the principle of conservation of mass, precisely timed serial measurements of patient weight, plasma and urine creatinine concentration, and urine volume were used to calculate Crprod-rate over 3 consecutive periods: a baseline period immediately before surgery (period 0), the 24-hour period starting from induction of anesthesia (period 1), and again from 24 to 48 hours after induction of anesthesia (period 2). The primary outcome was change in Crprod-rate from period 0 to period 1 (∆Crprod-rate0-1). Median Crprod-rate0 was 5.4 (interquartile range [IQR], 4.7-5.7) μmol/kg/h at baseline and increased to 6.1 (IQR, 5.6-6.5) μmol/kg/h during period 1, a median increase of 14% (95% CI, 8%-27%; p = 0.002). ∆Crprod-rate0-1 ranged from -58% to +129%, with an increase above baseline in 25 patients (76%) and an increase by ≥30% above baseline in 10 patients (30%).ConclusionsPerioperative Crprod-rate increased from baseline in patients undergoing cardiac surgery. This may represent a mechanism for an earlier creatinine-based signal of renal injury than previously thought possible.Copyright © 2022 Elsevier Inc. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…