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Diltiazem infusion for renal protection in cardiac surgical patients with preexisting renal dysfunction

Bergman, ASF; Odar-Cederlof, I; Westman, Lars LU ; Bjellerup, P; Höglund, Peter LU and Ohqvist, G (2002) In Journal of Cardiothoracic and Vascular Anesthesia 16(3). p.294-299
Abstract
Objective: To evaluate if the calcium channel blocker diltiazem protects postoperatively renal function in cardiac surgical patients with preexisting mild-to-moderate renal dysfunction. Design: Prospective, randomized, placebo-controlled, double-blind, clinical study. Setting: Cardiothoracic anesthesia department at a university hospital. Participants: Adult patients undergoing elective cardiac surgery using cardiopulmonary bypass, with a preoperatively elevated serum creatinine level (n = 24). Interventions: Randomized infusions of diltiazem (bolus 0.25 mg/kg followed by a continuous infusion of 1.7 pg/kg/min) (DTZ, n = 12) or placebo (C, n = 12) were started 30 minutes before induction of anesthesia and continued for 24 hours.... (More)
Objective: To evaluate if the calcium channel blocker diltiazem protects postoperatively renal function in cardiac surgical patients with preexisting mild-to-moderate renal dysfunction. Design: Prospective, randomized, placebo-controlled, double-blind, clinical study. Setting: Cardiothoracic anesthesia department at a university hospital. Participants: Adult patients undergoing elective cardiac surgery using cardiopulmonary bypass, with a preoperatively elevated serum creatinine level (n = 24). Interventions: Randomized infusions of diltiazem (bolus 0.25 mg/kg followed by a continuous infusion of 1.7 pg/kg/min) (DTZ, n = 12) or placebo (C, n = 12) were started 30 minutes before induction of anesthesia and continued for 24 hours. Measurements and Main Results: Median plasma concentrations of diltiazem (DTZ group) were 79 mug/L before cardiopulmonary bypass, 67 mug/L at the end of cardiopulmonary bypass, and 164 mug/L at 24 hours postoperatively. Serum creatinine levels; on postoperative days 1, 3, and 5; and 3 weeks postoperatively were similar between groups. lohexol clearance did not differ between the groups on day 5 but was higher in the DTZ group than in the placebo group 3 weeks after surgery (median, 51 v 40 mL/min/1.73 m(2); p < 0.05). Urinary N-acetyl-β-glucosamidase concentrations were similar between the groups during the study but were increased from baseline on days 2 and 4 and 3 weeks postoperatively. Conclusion: Diltiazem can be safely used in patients who have mild-to-moderate renal dysfunction and undergo cardiac surgery using cardiopulmonary bypass. Within the limits of this study, the data suggest that addition of prophylactic diltiazem may prevent further glomerular damage resulting from cardiopulmonary bypass and may improve glomerular function 3 weeks after cardiac surgery. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
postoperative complications, function, kidney, diltiazem, cardiac surgery, anesthesia, calcium antagonists
in
Journal of Cardiothoracic and Vascular Anesthesia
volume
16
issue
3
pages
294 - 299
publisher
W B Saunders
external identifiers
  • wos:000176417200006
  • pmid:12073199
  • scopus:0036017624
ISSN
1532-8422
DOI
10.1053/jcan.2002.124136
language
English
LU publication?
yes
id
551ac358-c54c-4c7e-8096-be5b49a42252 (old id 334505)
date added to LUP
2007-08-09 15:26:32
date last changed
2017-01-01 05:17:08
@article{551ac358-c54c-4c7e-8096-be5b49a42252,
  abstract     = {Objective: To evaluate if the calcium channel blocker diltiazem protects postoperatively renal function in cardiac surgical patients with preexisting mild-to-moderate renal dysfunction. Design: Prospective, randomized, placebo-controlled, double-blind, clinical study. Setting: Cardiothoracic anesthesia department at a university hospital. Participants: Adult patients undergoing elective cardiac surgery using cardiopulmonary bypass, with a preoperatively elevated serum creatinine level (n = 24). Interventions: Randomized infusions of diltiazem (bolus 0.25 mg/kg followed by a continuous infusion of 1.7 pg/kg/min) (DTZ, n = 12) or placebo (C, n = 12) were started 30 minutes before induction of anesthesia and continued for 24 hours. Measurements and Main Results: Median plasma concentrations of diltiazem (DTZ group) were 79 mug/L before cardiopulmonary bypass, 67 mug/L at the end of cardiopulmonary bypass, and 164 mug/L at 24 hours postoperatively. Serum creatinine levels; on postoperative days 1, 3, and 5; and 3 weeks postoperatively were similar between groups. lohexol clearance did not differ between the groups on day 5 but was higher in the DTZ group than in the placebo group 3 weeks after surgery (median, 51 v 40 mL/min/1.73 m(2); p &lt; 0.05). Urinary N-acetyl-β-glucosamidase concentrations were similar between the groups during the study but were increased from baseline on days 2 and 4 and 3 weeks postoperatively. Conclusion: Diltiazem can be safely used in patients who have mild-to-moderate renal dysfunction and undergo cardiac surgery using cardiopulmonary bypass. Within the limits of this study, the data suggest that addition of prophylactic diltiazem may prevent further glomerular damage resulting from cardiopulmonary bypass and may improve glomerular function 3 weeks after cardiac surgery.},
  author       = {Bergman, ASF and Odar-Cederlof, I and Westman, Lars and Bjellerup, P and Höglund, Peter and Ohqvist, G},
  issn         = {1532-8422},
  keyword      = {postoperative complications,function,kidney,diltiazem,cardiac surgery,anesthesia,calcium antagonists},
  language     = {eng},
  number       = {3},
  pages        = {294--299},
  publisher    = {W B Saunders},
  series       = {Journal of Cardiothoracic and Vascular Anesthesia},
  title        = {Diltiazem infusion for renal protection in cardiac surgical patients with preexisting renal dysfunction},
  url          = {http://dx.doi.org/10.1053/jcan.2002.124136},
  volume       = {16},
  year         = {2002},
}