Postoperative acute kidney injury is associated with hemoglobinemia and an enhanced oxidative stress response.

Acute kidney injury (AKI) frequently afflicts patients undergoing cardiopulmonary bypass and independently predicts death. Both hemoglobinemia and myoglobinemia are independent predictors of postoperative AKI. Release of free hemeproteins into the circulation is known to cause oxidative injury to the kidneys. This study tested the hypothesis that postoperative AKI is associated with both enhanced intraoperative hemeprotein release and increased lipid peroxidation assessed by measuring F₂-isoprostanes and isofurans. In a case-control study nested within an ongoing randomized trial of perioperative statin treatment and AKI, we compared levels of F₂-isoprostanes and isofurans with plasma levels of free hemoglobin and myoglobin in 10 cardiac surgery AKI patients to those of 10 risk-matched controls. Peak plasma free hemoglobin concentrations were significantly higher in AKI subjects (289.0 ± 37.8 versus 104.4 ± 36.5mg/dl, P = 0.01), whereas plasma myoglobin concentrations were similar between groups. The change in plasma F₂-isoprostane and isofuran levels (repeated-measures ANOVA, P = 0.02 and P = 0.001, respectively) as well as the change in urine isofuran levels (P = 0.04) was significantly greater in AKI subjects. In addition, change in peak plasma isofuran levels correlated not only with peak free plasma hemoglobin concentrations (r² = 0.39, P = 0.001) but also with peak change in serum creatinine (r² = 0.20, P = 0.01). Postoperative AKI is associated with both enhanced intraoperative hemeprotein release and enhanced lipid peroxidation. The correlations among hemoglobinemia, lipid peroxidation, and AKI indicate a potential role for hemeprotein-induced oxidative damage in the pathogenesis of postoperative AKI.

Billings FT 4th ，Ball SK ，Roberts LJ 2nd ，Pretorius M ... -  《-》

Acetaminophen attenuates lipid peroxidation in children undergoing cardiopulmonary bypass.

Simpson SA ，Zaccagni H ，Bichell DP ，Christian KG ，Mettler BA ，Donahue BS ，Roberts LJ 2nd ，Pretorius M ... -  《Pediatric Critical Care Medicine》

Cell-free hemoglobin mediated oxidative stress is associated with acute kidney injury and renal replacement therapy in severe falciparum malaria: an observational study.

Plewes K ，Kingston HWF ，Ghose A ，Maude RJ ，Herdman MT ，Leopold SJ ，Ishioka H ，Hasan MMU ，Haider MS ，Alam S ，Piera KA ，Charunwatthana P ，Silamut K ，Yeo TW ，Faiz MA ，Lee SJ ，Mukaka M ，Turner GDH ，Anstey NM ，Jackson Roberts L 2nd ，White NJ ，Day NPJ ，Hossain MA ，Dondorp AM ... -  《-》

Perioperative intravenous acetaminophen attenuates lipid peroxidation in adults undergoing cardiopulmonary bypass: a randomized clinical trial.

Billings FT 4th ，Petracek MR ，Roberts LJ 2nd ，Pretorius M ... -  《PLoS One》

Relationship between intraoperative serum lactate and hemoglobin levels on postoperative renal function in patients undergoing elective cardiac surgery.

We examined the relationship between serum lactate and hemoglobin levels on renal function and postoperative outcome in low-risk elective coronary artery bypass graft (CABG) patients. Intraoperative hemoglobin and lactate levels were measured in elective isolated CABG patients. Patients with renal dysfunction (baseline creatinine>2 mg/dL) were excluded. Multivariate logistic regression was used to determine associations between lactate, hemoglobin, and acute kidney injury (AKI). A total of 375 patients met study requirements, and 56/375 (15%) developed AKI. Of the patients who developed AKI, 43/278 (15.5%) were males, 13/97 (13.4%) females, and 11/44 (25%) African-Americans. Bivariate analysis between AKI and non-AKI subgroups found significant differences in age, race, baseline estimated glomerular filtration rate, preoperative hemoglobin, peak serum lactate, initial hemoglobin, and nadir hemoglobin. A high peak Lactate level (odds ratio [OR] 1.44[1.15-1.82]), low hemoglobin (OR 0.69[0.49-0.96]), and African American race (OR 2.26[0.96-5.05]) were independently associated with acute kidney injury. A significant relationship between decreasing intraoperative hemoglobin and increasing intraoperative serum lactate levels was observed exclusively in patients who developed postoperative AKI. Serum creatinine levels peaked, on average, 48 h postoperatively in the AKI subset of patients. In this series, 15% of patients who underwent elective cardiopulmonary bypass developed transient acute renal dysfunction. High lactate levels and low hemoglobin levels during cardiopulmonary bypass were associated with an increased risk of kidney injury.

Mitchell SC ，Vinnakota A ，Deo SV ，Markowitz AH ，Sareyyupoglu B ，Elgudin Y ，Medalion B ，Tzagournis A ，Sabik J ，Park SJ ... -  《-》