Impact of Isolyte Versus 0.9% Saline on Postoperative Event of Acute Kidney Injury Assayed by Urinary [TIMP-2] × [IGFBP7] in Patients Undergoing Cardiac Surgery

Nathan M. Lee, Lev Deriy, Timothy R. Petersen, Vallabh O. Shah, Michael Hutchens, Neal S. Gerstein

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: Administration of excess chloride in 0.9% normal saline (NS) decreases renal perfusion and glomerular filtration rate, thereby increasing the risk for acute kidney injury (AKI). In this study, the effect of NS versus Isolyte use during cardiac surgery on urinary levels of tissue inhibitor of metalloproteinase 2 and insulin-like growth factor-binding protein 7 [TIMP-2] × [IGFBP7] and postoperative risk of AKI were examined. Design: Prospective, randomized, and single-blinded trial. Setting: Single university medical center. Participants: Thirty patients over 18 years without chronic renal insufficiency or recent AKI undergoing elective cardiac surgery. Interventions: Subjects were randomized to receive either NS or Isolyte during the intraoperative period. Measurements and Main Results: The primary outcome was the change in urinary levels of [TIMP2] × [IGFBP7] from before surgery to 24 hours postoperatively. Secondary outcomes included serum creatinine pre- and postoperatively at 24 and 48 hours, serum chloride pre- and postoperatively at 24 and 48 hours, need for dialysis prior to discharge, and arterial pH measured 24 hours postoperatively. Sixteen patients received NS and 14 patients received Isolyte. Three patients developed AKI within the first 3 postoperative days, all in the NS group. The authors found increases in [TIMP-2] × [IGFBP7] in both groups. However, the difference in this increase between study arms was not significant (p = 0.92; -0.097 to 0.107). Conclusion: The authors observed no change in urinary [TIMP-] × [IGFBP7] levels in patients receiving NS versus Isolyte during cardiac surgery. Future larger studies in patients at higher risk for AKI are recommended to evaluate the impact of high- versus lower-chloride solutions on the risk of postoperative AKI after cardiac surgery.

Original languageEnglish (US)
JournalJournal of Cardiothoracic and Vascular Anesthesia
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Tissue Inhibitor of Metalloproteinase-2
Acute Kidney Injury
Thoracic Surgery
Chlorides
Intraoperative Period
Serum
Glomerular Filtration Rate
Chronic Renal Insufficiency
insulin-like growth factor binding protein-related protein 1
Dialysis
Creatinine
Perfusion
Kidney

Keywords

  • 0.9% saline
  • acute kidney injury
  • cardiac surgery
  • IGFBP7
  • Isolyte
  • TIMP-2

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Impact of Isolyte Versus 0.9% Saline on Postoperative Event of Acute Kidney Injury Assayed by Urinary [TIMP-2] × [IGFBP7] in Patients Undergoing Cardiac Surgery. / Lee, Nathan M.; Deriy, Lev; Petersen, Timothy R.; Shah, Vallabh O.; Hutchens, Michael; Gerstein, Neal S.

In: Journal of Cardiothoracic and Vascular Anesthesia, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Objective: Administration of excess chloride in 0.9{\%} normal saline (NS) decreases renal perfusion and glomerular filtration rate, thereby increasing the risk for acute kidney injury (AKI). In this study, the effect of NS versus Isolyte use during cardiac surgery on urinary levels of tissue inhibitor of metalloproteinase 2 and insulin-like growth factor-binding protein 7 [TIMP-2] × [IGFBP7] and postoperative risk of AKI were examined. Design: Prospective, randomized, and single-blinded trial. Setting: Single university medical center. Participants: Thirty patients over 18 years without chronic renal insufficiency or recent AKI undergoing elective cardiac surgery. Interventions: Subjects were randomized to receive either NS or Isolyte during the intraoperative period. Measurements and Main Results: The primary outcome was the change in urinary levels of [TIMP2] × [IGFBP7] from before surgery to 24 hours postoperatively. Secondary outcomes included serum creatinine pre- and postoperatively at 24 and 48 hours, serum chloride pre- and postoperatively at 24 and 48 hours, need for dialysis prior to discharge, and arterial pH measured 24 hours postoperatively. Sixteen patients received NS and 14 patients received Isolyte. Three patients developed AKI within the first 3 postoperative days, all in the NS group. The authors found increases in [TIMP-2] × [IGFBP7] in both groups. However, the difference in this increase between study arms was not significant (p = 0.92; -0.097 to 0.107). Conclusion: The authors observed no change in urinary [TIMP-] × [IGFBP7] levels in patients receiving NS versus Isolyte during cardiac surgery. Future larger studies in patients at higher risk for AKI are recommended to evaluate the impact of high- versus lower-chloride solutions on the risk of postoperative AKI after cardiac surgery.",
keywords = "0.9{\%} saline, acute kidney injury, cardiac surgery, IGFBP7, Isolyte, TIMP-2",
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AU - Lee, Nathan M.

AU - Deriy, Lev

AU - Petersen, Timothy R.

AU - Shah, Vallabh O.

AU - Hutchens, Michael

AU - Gerstein, Neal S.

PY - 2018/1/1

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N2 - Objective: Administration of excess chloride in 0.9% normal saline (NS) decreases renal perfusion and glomerular filtration rate, thereby increasing the risk for acute kidney injury (AKI). In this study, the effect of NS versus Isolyte use during cardiac surgery on urinary levels of tissue inhibitor of metalloproteinase 2 and insulin-like growth factor-binding protein 7 [TIMP-2] × [IGFBP7] and postoperative risk of AKI were examined. Design: Prospective, randomized, and single-blinded trial. Setting: Single university medical center. Participants: Thirty patients over 18 years without chronic renal insufficiency or recent AKI undergoing elective cardiac surgery. Interventions: Subjects were randomized to receive either NS or Isolyte during the intraoperative period. Measurements and Main Results: The primary outcome was the change in urinary levels of [TIMP2] × [IGFBP7] from before surgery to 24 hours postoperatively. Secondary outcomes included serum creatinine pre- and postoperatively at 24 and 48 hours, serum chloride pre- and postoperatively at 24 and 48 hours, need for dialysis prior to discharge, and arterial pH measured 24 hours postoperatively. Sixteen patients received NS and 14 patients received Isolyte. Three patients developed AKI within the first 3 postoperative days, all in the NS group. The authors found increases in [TIMP-2] × [IGFBP7] in both groups. However, the difference in this increase between study arms was not significant (p = 0.92; -0.097 to 0.107). Conclusion: The authors observed no change in urinary [TIMP-] × [IGFBP7] levels in patients receiving NS versus Isolyte during cardiac surgery. Future larger studies in patients at higher risk for AKI are recommended to evaluate the impact of high- versus lower-chloride solutions on the risk of postoperative AKI after cardiac surgery.

AB - Objective: Administration of excess chloride in 0.9% normal saline (NS) decreases renal perfusion and glomerular filtration rate, thereby increasing the risk for acute kidney injury (AKI). In this study, the effect of NS versus Isolyte use during cardiac surgery on urinary levels of tissue inhibitor of metalloproteinase 2 and insulin-like growth factor-binding protein 7 [TIMP-2] × [IGFBP7] and postoperative risk of AKI were examined. Design: Prospective, randomized, and single-blinded trial. Setting: Single university medical center. Participants: Thirty patients over 18 years without chronic renal insufficiency or recent AKI undergoing elective cardiac surgery. Interventions: Subjects were randomized to receive either NS or Isolyte during the intraoperative period. Measurements and Main Results: The primary outcome was the change in urinary levels of [TIMP2] × [IGFBP7] from before surgery to 24 hours postoperatively. Secondary outcomes included serum creatinine pre- and postoperatively at 24 and 48 hours, serum chloride pre- and postoperatively at 24 and 48 hours, need for dialysis prior to discharge, and arterial pH measured 24 hours postoperatively. Sixteen patients received NS and 14 patients received Isolyte. Three patients developed AKI within the first 3 postoperative days, all in the NS group. The authors found increases in [TIMP-2] × [IGFBP7] in both groups. However, the difference in this increase between study arms was not significant (p = 0.92; -0.097 to 0.107). Conclusion: The authors observed no change in urinary [TIMP-] × [IGFBP7] levels in patients receiving NS versus Isolyte during cardiac surgery. Future larger studies in patients at higher risk for AKI are recommended to evaluate the impact of high- versus lower-chloride solutions on the risk of postoperative AKI after cardiac surgery.

KW - 0.9% saline

KW - acute kidney injury

KW - cardiac surgery

KW - IGFBP7

KW - Isolyte

KW - TIMP-2

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