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BJA Advance Access published online on September 17, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aeh266
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted July 19, 2004

Clinical Investigation

Effect of dexamethasone on perioperative renal function impairment during cardiac surgery with cardiopulmonary bypass

B. G. Loef 1*, R. H. Henning 2, A. H. Epema 3, G. W. Rietman 3, W. van Oeveren 4, G. J. Navis 5, and T. Ebels 4

1 Cardiothoracic Intensive Care Unit, University Hospital Groningen, Groningen, The Netherlands
2 Department of Clinical Pharmacology, University Hospital Groningen, Groningen, The Netherlands
3 Department of Anesthesiology, University Hospital Groningen, Groningen, The Netherlands
4 Department of Cardiopulmonary Surgery, University Hospital Groningen, Groningen, The Netherlands
5 Department of Nephrology, University Hospital Groningen, Groningen, The Netherlands

* To whom correspondence should be addressed. E-mail: b.g.loef{at}thorax.azg.nl.


  Abstract

Background. In cardiac surgery with cardiopulmonary bypass (CPB), corticosteroids are administered to attenuate the physiological changes caused by the systemic inflammatory response. The effects of corticosteroids on CPB-associated renal damage have not been documented. The purpose of this study was to evaluate the effects of dexamethasone on perioperative renal dysfunction in patients undergoing cardiac surgery with CPB.

Methods. Renal damage was prospectively studied in 20 patients without concomitant morbidity undergoing coronary artery surgery with CPB. Patients were randomized in a double-blind fashion to receive dexamethasone or placebo. Markers of glomerular function (creatinine clearance) and damage (microalbuminuria), and markers of tubular function (fractional excretion of sodium and free water clearance) and damage (N-acetyl-{beta}-D glucosaminidase (NAG)) were evaluated in addition to plasma and urinary glucose levels. Plasma and urinary specimens were obtained at the following time periods: (1) baseline, during the 12 h before surgery; (2) skin incision before heparinization; (3) from heparinization until the end of CPB; (4) during the 2 h following weaning from CPB; (5) in the intensive care unit from 2 to 6 h after weaning of CBP; (6) and from 36 to 60 h after weaning of CPB.

Results. CPB was associated with an increase in markers in the placebo group, which returned to baseline during the second postoperative day, demonstrating a transient impairment of glomerular and tubular renal function. Similar patterns were observed in patients treated with dexamethasone. While postoperative glycosuria was significantly higher in the dexamethasone-treated group, no other differences between groups were observed.

Conclusion. Dexamethasone administration before CPB has no protective effect on perioperative renal dysfunction in low-risk cardiac surgical patients.

Keywords: complications, renal damage; heart, cardiopulmonary bypass; markers, renal; steroid, dexamethasone.
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