scholarly journals Efficacy of Statin Therapy Related to Baseline Renal Function in Patients with Rheumatic Heart Disease Undergoing Cardiac Surgery

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Rongjun Zou ◽  
Wanting Shi ◽  
Jun Tao ◽  
Xifeng Lin ◽  
Dingwen Zhang ◽  
...  
Keyword(s):  
Renal Function ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Renal Impairment ◽  
Hospital Stay ◽  
Normal Renal Function ◽  
Icu Stay ◽  
Drainage Time ◽  
Baseline Renal Function ◽  
Rheumatic Heart

Background. Renal impairment increases the risk of cardiovascular events and perioperative complications in patients with heart valve disease. This study aimed to determine the perioperative benefit of statin treatment related to baseline renal function in patients with rheumatic heart disease (RHD) who had cardiac surgery. Methods and Results. We performed a retrospective study on 136 patients with RHD who underwent valve replacement surgery. The mean age of the patients was 56.2 years, 59.6% were female, 8.8% patients had diabetes mellitus, and 27.2% of patients had hypertension. Overall, 3 patients died, 2 underwent reoperation, and 25 underwent thoracentesis during the study period. For patients with renal impairment, there was a higher risk of thoracic puncture (odds ratio [OR]: 3.33; 95% confidence interval [CI]: 1.36, 8.11; P<0.01) and a longer time of drainage (difference in means: 1; 95% CI: 0.88, 1.12; P<0.01), intensive care unit (ICU) stay (difference in means: 0.2; 95% CI: 0.17, 0.23; P=0.02), and hospital stay (difference in means: 6.6; 95% CI: 6.15, 7.05; P<0.01) compared with normal renal function. Furthermore, statins were associated with a reduction in drainage time (difference in means: −1.50; 95% CI: −1.86, −1.14; P=0.02), ICU stay (difference in means: −0.30; 95% CI: −0.40, −0.20; P=0.05), and hospital stay (difference in means: −5.40; 95% CI: −6.57, −4.23; P<0.01) in patients with renal impairment (interaction, P≤0.05 for all), but not in those with normal renal function. Conclusion. Statins have a greater clinical benefit in perioperative cardiac surgery with renal impairment. Statins are associated with a comparatively lower risk of thoracic puncture, as well as a reduced trend toward a reduction in drainage time, ICU stay, and hospital stay.

scholarly journals Benefits of ultra-fast-track anesthesia for children with congenital heart disease undergoing cardiac surgery

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jing Xu ◽  
Guanghua Zhou ◽  
Yanpei Li ◽  
Na Li
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Hospital Stay ◽  
Congenital Heart ◽  
Fast Track ◽  
Adverse Reactions ◽  
Icu Stay ◽  
Anesthesia Group ◽  
Extubation Time

Abstract Background To compare the outcomes of ultra-fast-track anesthesia (UFTA) and conventional anesthesia in cardiac surgery for children with congenital heart disease (CHD) and low birth weight. Methods One hundred and ninety-four CHD children, aged 6 months to 2 years, weighting 5 to 10 kg, were selected for this study. The 94 boys and 100 girls with the American Society of Anesthesiologists (ASA) physical status III and IV were randomly divided into two groups each consisting of 97 patients, and were subjected to ultra-fast-track and conventional anesthesia for cardiac surgery. For children in UFTA group, sevoflurane was stopped when cardiopulmonary bypass (CPB) started and cis-atracurium was stopped at the beginning of rewarming, and remifentanil (0.3 μg/kg/mim) was then infused. Propofol and remifentanil were discontinued at skin closure. 10 min after surgery, extubation was performed in operating room. For children in conventional anesthesia group, anesthesia was given routinely and they were directly sent to ICU with a tracheal tube. Extubation time, ICU stay and hospital stay after operation were recorded. Sedation-agitation scores (SAS) were assessed and adverse reactions as well as other anesthesia –related events were recorded. Results The extubation time, ICU stay and hospital stay were significantly shorter in UFTA group (P < 0.05) and SAS at extubation was lower in UFTA group than in conventional anesthesia group, but similar in other time points. For both groups, no airway obstruction and other serious complications occurred, and incidence of other anesthesia –related events were low. Conclusions UFTA shortens extubation time, ICU stay and hospital stay for children with CHD and does not increase SAS and incidence of adverse reactions.

Impact of Baseline Renal Function on Transfusion-Independence Response, Survival, and Transformation to Acute Myeloid Leukemia in Patients with Deletion 5q: A Sub-Analysis of the MDS-003 Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5088-5088 ◽  
Author(s):  
Minoo Battiwalla ◽  
Tommy Fu ◽  
Robert D. Knight ◽  
Alan F. List
Keyword(s):  
Overall Survival ◽  
Renal Function ◽  
Renal Impairment ◽  
Normal Renal Function ◽  
Myeloid Leukemia ◽  
Severe Renal Impairment ◽  
Transfusion Independence ◽  
Severe Impairment ◽  
The Impact ◽  
Baseline Renal Function

Abstract Introduction: Lenalidomide reduced transfusion requirements and reversed cytologic and cytogenetic abnormalities in patients who have myelodysplastic syndrome (MDS) with the chromosome 5q31 deletion del(5q)] (List et al., NEJM 2006). Dose-adjusted lenalidomide is safe and effective in MDS patients with del(5q) and severe renal impairment (Knop et al., Leuk Lymph 2008), but the impact of baseline renal function on outcomes has not been specifically studied. This MDS-003 clinical trial sub-analysis investigates the impact of baseline renal function on the transfusion-independence (TI) response, overall survival, and transformation to acute myeloid leukemia (AML). Methods: Transfusion-dependent, Low/Int-1-risk patients with primary MDS and del(5q) with/without additional cytogenetic abnormalities were treated with lenalidomide 10 mg daily for 21 days every 28 days. Patients were treated until disease progression, treatment failure, or treatment-limiting adverse events. This sub-analysis included patients with normal renal function (creatinine clearance [CrCl] &gt;80 mL/min) and patients with mild (CrCl 50–80 mL/min), moderate (30–50 mL/min), or severe renal impairment (CrCl &lt;30 mL/min). CrCl was calculated according to the Cockcroft-Gault formula. Red blood cell (RBC) transfusion-dependent anemia was defined as having received ≥2 units of RBCs within 8 weeks of the first day of study treatment. Neutropenia was defined as a baseline absolute neutrophil count of &lt;1,000/μL. Thrombocytopenia was defined as a baseline platelet count of &lt; 100,000/μL. TI response, overall survival, and transformation to AML were assessed. Results: Of 148 patients enrolled in the study, 70 patients had normal renal function and 70 patients had renal impairment (47 mild, 19 moderate and 4 severe impairment; with renal data missing for 8 patients). The TI response was 44/70 (63%) for patients with normal renal function and 48/70 (69%) for patients with impaired renal function (P=0.47). In the subcategories, the TI responses were 79%, 53% and 25% for mild, moderate and severe impairment, respectively (P=0.07, P=0.42 and P=0.13 vs. normal function). Renal impairment resulted in shorter median overall survival compared with no renal impairment (hazard ratio of 2.88, 95% confidence interval, 2.24–3.45). The transformation to AML rate was 19% for normal patients and 20% for patients with renal impairment. Conclusion: In this analysis, baseline renal function does not have a significant impact on achieving transfusion independence or transformation to AML. Patients with moderate to severe renal impairment had a shorter survival than patients with normal renal function.

scholarly journals Determinants of prolonged length of hospital stay after cardiac surgery: impact of rheumatic heart disease

2015 ◽  
Vol 2 (3) ◽  
Author(s):  
Mariângela F Pato ◽  
Cláudio L Gelape ◽  
Tammy JM Cassiano ◽  
Adriano Carvalho ◽  
Priscila R Cintra ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Disease ◽  
Hospital Stay ◽  
Rheumatic Heart Disease ◽  
Length Of Hospital Stay ◽  
Prolonged Length ◽  
Rheumatic Heart

scholarly journals Off-Pump Technique May Prevent Worsening of Renal Function in CAD with CKD Undergoing CABG

2021 ◽  
Vol 05 (01) ◽  
pp. 007-011
Author(s):  
Shaheen Afsal ◽  
K. Sujani ◽  
Shashank Viswanathan ◽  
Akshay Bhati ◽  
Harish BR ◽  
...  
Keyword(s):  
Renal Function ◽  
Cardiac Surgery ◽  
Serum Creatinine ◽  
Renal Dysfunction ◽  
Normal Renal Function ◽  
Artery Bypass ◽  
Significant Proportion ◽  
Renal Dialysis ◽  
Off Pump ◽  
Preoperative Serum

AbstractCardiovascular disease (CVD) is a major cause for a significant proportion of all deaths and disability worldwide. Postoperative renal dysfunction following cardiac surgery is not an uncommon complication of cardiac surgery, which has serious implications with regard to morbidity, mortality, financial expenditure, and resource utilization. This study was performed to compare outcomes of patients with preoperative renal dysfunction with those having normal renal function undergoing off-pump coronary artery bypass grafting (OPCABG). Patients were divided into two categories, depending on their preoperative serum creatinine and glomerular filtration rate (GFR). The preoperative renal dysfunction was defined as serum creatinine >1.3 mg/dL and/or estimated GFR (eGFR) of <60 mL/min/1.73 m2. The category A patients had normal renal function defined as serum creatinine ≤1.3 mg/dL and/or eGFR of ≥60 mL/min/1.73 m2 while the category B patients had preoperative renal dysfunction that did not necessitate renal dialysis. Blood samples were collected from both category patients for serum creatinine prior to surgery, following surgery, on postoperative days 1, 2, 3, 4, 5, and on the day of discharge. The occurrence of acute kidney injury (AKI) was defined as an increase in the serum creatinine levels of ≥0.3 mg/dL within 48 hours or an increase of ≥1.5 above baseline known or presumed to have occurred within the previous 7 days based on Kidney Disease Improving Global Outcomes criteria. This study demonstrated that there was worsening of renal function in 7.4% of patients with normal renal function and 10.74% of patients with renal dysfunction that was not statistically different. Based on the results, we conclude that preoperative renal dysfunction may be a contributing predictor of AKI following OPCABG, and we recommend that the patients with more severe renal dysfunction with eGFR of 45–60 mL/min should be studied to demonstrate this hypothesis.

P0234LOW URINARY CITRATE LEVELS ARE NOT SPECIFIC OF AUTOSOMAL POLYCYSTIC KIDNEY DISEASE (ADPKD) AND ARE PRESENT WHEN RENAL FUNCTION IS IMPAIRED IN ALL NEPHROPATIES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Francisco-Jose Borrego-Utiel ◽  
Enoc Merino Garcia ◽  
Isidoro Herrera ◽  
Clara Moriana Dominguez ◽  
Victoria Camacho Reina ◽  
...  
Keyword(s):  
Renal Function ◽  
Uric Acid ◽  
Kidney Disease ◽  
Renal Impairment ◽  
Polycystic Kidney Disease ◽  
Normal Renal Function ◽  
Serum Bicarbonate ◽  
Polycystic Kidney ◽  
Glomerular Diseases ◽  
Urinary Citrate

Abstract Background and Aims In polycystic kidney disease (PKD) it is frequently found a reduction in urinary citrate that is related with degree of renal impairment but it is unknown if this alteration is specific or if it is also present in other nephropathies. Recently it has been suggested that urinary citrate could be a marker of covert metabolic acidosis and reflects acid retention in chronic kidney disease (CKD). Our aim was to compare urinary citrate in PKD with other renal diseases and to show its relation with serum bicarbonate and excretion of uric acid and calcium. Method We determined citrate, calcium and uric acid in 24-hour urine in patients with PKD and with other nephropathies with varied degree of renal impairment followed in a outpatient clinic of nephrology. Results We included 291 patients, 119 with glomerular diseases, 116 with PKD, 21 with other nephropathies, and 35 patients with normal renal function. Urinary citrate was higher in women (Females 309±251 mg/gCr vs. males 181±145 mg/gCr, p&lt;0.001) and in patients with normal renal function (normal 380±210 mg/gCr; PKD 203±166 mg/gCr; glomerular 279±282 mg/gCr; p&lt;0,001). PKD patients showed similar values of urinary citrate to patients with glomerular diseases and with other nephropathies. We observed a progressive reduction in urinary citrate parallel to degree of renal impairment, in a comparable way among patients with PKD and glomerular diseases. We did not observe a relationship between urinary citrate and serum bicarbonate levels. Calcium and uric acid elimination in ADPKD patients was similar to other nephropathies and lower to patients with normal renal function. However, serum uric acid was significantly higher in glomerular patients than other nephropathies after adjust with glomerular filtration rate and sex. Conclusion Hypocitraturia is not specific of PKD but it is also present in all nephropathies. Urinary citrate are related to degree of renal impairment and it is not related with serum bicarbonate. We think that it could be interesting to study urinary citrate as a marker of renal function and its role as prognostic factor of renal deterioration.

scholarly journals Pharmacokinetics of lamivudine in human immunodeficiency virus-infected patients with renal dysfunction.

1996 ◽  
Vol 40 (6) ◽  
pp. 1514-1519 ◽  
Author(s):  
A E Heald ◽  
P H Hsyu ◽  
G J Yuen ◽  
P Robinson ◽  
P Mydlow ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Renal Function ◽  
Renal Impairment ◽  
Normal Renal Function ◽  
Severe Renal Impairment ◽  
Moderate Renal Impairment ◽  
Pharmacokinetic Parameters ◽  
Geometric Means ◽  
Immunodeficiency Virus

The purpose of this study was to determine the safety and pharmacokinetics of lamivudine (3TC), a nucleoside analog that has shown potent in vitro and recent in vivo activity against human immunodeficiency virus. Sixteen human immunodeficiency virus-infected patients, six with normal renal function (creatinine clearance [CLCR], > or = 60 ml/min), four with moderate renal impairment (CLCR, 10 to 40 ml/min), and six with severe renal impairment (CLCR, < 10 ml/min), were enrolled in the study. After an overnight fast, patients were administered 300 mg of 3TC orally. Blood was obtained before 3TC administration and 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, 24, 32, 40, and 48 h afterward. Timed urine collections were performed for patients able to produce urine. Serum and urine were assayed for 3TC by reverse-phase high-performance liquid chromatography with UV detection. Pharmacokinetic parameters were calculated by using standard noncompartmental techniques. The peak concentration of 3TC increased with decreasing renal function; geometric means were 2,524, 3,538, and 5,684 ng/ml for patients with normal renal function, moderate renal impairment, and severe renal impairment, respectively. The terminal half-life also increased with decreasing renal function; geometric means were 11.5, 14.1, and 20.7 h for patients with normal renal function, moderate renal impairment, and severe renal impairment, respectively. Both oral and renal clearances were linearly correlated with CLCR. A 300-mg dose of 3TC was well tolerated by all three patient groups. The pharmacokinetics of 3TC is profoundly affected by impaired renal function. Dosage adjustment, by either dose reduction or lengthening of the dosing interval, is warranted.

Insulin Degludec has Similar Pharmacokinetic Properties in Subjects with Renal Impairment and Subjects with Normal Renal Function

2012 ◽  
Vol 36 (5) ◽  
pp. S36
Author(s):  
István Kiss ◽  
Gerhard Arold ◽  
Susanne G. Bøttcher ◽  
Carsten Roepstorff ◽  
Jovana Kapor ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Impairment ◽  
Normal Renal Function ◽  
Insulin Degludec ◽  
Pharmacokinetic Properties
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