J Extra Corpor Technol 2024 , 56 , 45 – 54 Ó The Author ( s ), published by EDP Sciences , 2024 https :// doi . org / 10.1051 / ject / 2024004
Available online at : ject . edpsciences . org
ORIGINAL ARTICLE
Impact of extracorporeal haemoadsorption during prolonged cardiopulmonary bypass on the incidence of acute kidney injury
Nilufar Jabayeva ( MD ) 1 , Bolat Bekishev ( MD ) 1 , Timur Lesbekov ( MD ) 2 , Zhuldyz Nurmykhametova ( MD ) 3 ,* , Rymbay Kaliyev ( MD ) 3 , Linar Faizov ( MD ) 3 , Aidyn Kuanyshbek ( MD ) 1 , and Robertas Samalavicius ( PhD ) 4
1 Department of Anesthesiology and Intensive Care , National Research Cardiac Surgery Center , Astana 010000 , Kazakhstan 2 Department of Adult Cardiac Surgery , National Research Cardiac Surgery Center , Astana 010000 , Kazakhstan 3 Department of Perfusiology and assisted circulation laboratory , National Research Cardiac Surgery Center , Astana 010000 , Kazakhstan 4 Department of Anesthesia , Intensive Care and Pain Management , Vilnius University Hospital Santariskiu Clinics , Vilnius 01100 , Lithuania
Received 24 November 2023 , Accepted 4 March 2024
Abstract – The usage of cardiopulmonary bypass ( CPB ) in cardiothoracic surgery contributes to the activation of the inflammatory response . In certain cases , the systemic inflammatory response may be immoderate , leading to organ dysfunction , such as acute renal failure or multiorgan dysfunction . This study aimed to examine the effect of haemoadsorption ( HA ) therapy on inflammatory markers and renal damage indices during cardiopulmonary bypass and in the early postoperative period . We conducted a retrospective analysis of prospectively collected data in a single tertiary care center on patients operated between January 2021 and May 2022 . The levels of inflammatory markers and renal parameters in blood samples ( Interleukin ( IL ) 6 , C-reactive protein ( CRP ), white blood cells , lactate , procalcitonin ( PCT ), and NT-proBNP , urea , creatinine , glomerular filtration rate ( GFR ), mechanical ventilation days and intensive care unit ( ICU ) days ) were compared between the three groups . Data from the Jafron HA 330 ( n = 20 ) and Cyto- Sorb300 ( n = 20 ) groups were compared with those from the control group ( n = 20 ). All patients underwent cardiopulmonary bypass for more than 120 min . Baseline patient characteristics were similar in all three groups . Acute kidney injury ( AKI ) was diagnosed in 17 patients ( 28.3 %); seven patients were in the Jafron HA 330 , two in the CytoSorb300 , and eight in the control group . We found that IL1a , IL 6 , IL8 , Lactate dehydrogenase , PCT , NT-proBNP , CRP , Leukocyte , and TNFa had no significant or clinical difference between the CytoSorb 300 and Jafron HA 330 adsorber groups . Our results indicate that haemoadsorption therapy does not significantly reduce the risk of AKI after prolonged CPB , but decreases the need for renal replacement therapy .
Key words : Prolonged cardiopulmonary bypass , Haemoadsorption , Systemic inflammatory response syndrome , Acute kidney injury .
Introduction
Cardiopulmonary bypass ( CPB ) takes over the function of the heart and lungs during open-heart surgery , with a bloodless field and immobile heart [ 1 , 2 ]. However , CPB is often associated with systemic inflammatory responses due to traumatic stress , monocyte / macrophage activation , and coagulation [ 3 , 4 ]. During CPB , the extrication of several inflammatory molecules ( C3a , C5a , histamine , IL-6 , IL-8 , and TNF-a ) causes activation of cellular responses , which leads to the development of systemic inflammation , increased vascular pressure , permeability , and thrombosis [ 5 ].
It has been demonstrated that the effects of CPB-induced systemic inflammation can lead to adverse outcomes such as hemodynamic instability , coagulopathy , acute renal and other
* Corresponding author : zhyziknurik @ icloud . com organ failure , and even death [ 6 – 10 ]. Extracorporeal removal of inflammatory cytokines may improve the prognosis of patients following CPB use , given the association between elevated levels of pro-inflammatory cytokines and adverse clinical outcomes [ 11 , 12 ]. Different approaches have been created to reduce systemic inflammatory responses during CPB , such as pharmaceutical and non-medicament approaches ( removing inflammatory molecules by hemoperfusion , reducing surface area using mini circuits , and improving the biocompatibility of extracorporeal surfaces ) [ 3 , 13 ]. However , Clive Landis et al . [ 3 ] reported that only about a third of these approaches showed clinically improved efficacy . Therefore , the development of a new strategy to reduce systemic inflammation caused by CPB is still relevant .
The duration and severity of the harmful triggers associated with CPB might have a negative impact on the recovery of the
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