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The course of plasma alpha-1-microglobulin and haemolysis during cardiac surgery and the relationship to acute kidney injury, a pilot study

Metzsch, Carsten LU orcid ; Lindahl, Oscar ; Klarén, Martina ; Grins, Edgars LU orcid ; Ekroth, Annika ; Hansson, Stefan R. LU orcid ; Åkerström, Bo LU and Dardashti, Alain LU (2024) In Scandinavian Journal of Clinical and Laboratory Investigation 84(7-8). p.557-563
Abstract

Haemolysis occurring during cardiac surgery with cardiopulmonary bypass (CPB) is assumed to be a risk factor for postoperative acute kidney injury (AKI). Plasma alpha-1 microglobulin (A1M) may have a protective role as haem scavenger. The aim of this study was to evaluate the association between AKI and the degree of haemolysis and the course of A1M concentrations during cardiac surgery, respectively. We analysed plasma concentrations of free haemoglobin (pfHb) and A1M in 25 patients undergoing cardiac surgery: before CPB; during CPB in 15 min intervals; after CPB; and at four additional time points until 24 h after surgery. Markers of kidney function were followed until 4 days after surgery. Detection of AKI was based on the KDIGO... (More)

Haemolysis occurring during cardiac surgery with cardiopulmonary bypass (CPB) is assumed to be a risk factor for postoperative acute kidney injury (AKI). Plasma alpha-1 microglobulin (A1M) may have a protective role as haem scavenger. The aim of this study was to evaluate the association between AKI and the degree of haemolysis and the course of A1M concentrations during cardiac surgery, respectively. We analysed plasma concentrations of free haemoglobin (pfHb) and A1M in 25 patients undergoing cardiac surgery: before CPB; during CPB in 15 min intervals; after CPB; and at four additional time points until 24 h after surgery. Markers of kidney function were followed until 4 days after surgery. Detection of AKI was based on the KDIGO (Kidney Disease, Improving Global Outcome) criteria. The plasma concentration of free haemoglobin during CPB was found to be significantly higher in patients with postoperative AKI at 60 min after start of CPB [mean 1379 µg/mL (95% CI: 1037–1721)]; compared to [820 µg/mL (622–1018)]; p = 0.034, in patients without AKI, and at one hour post-CPB [2600 µg/mL (969–4230)] vs [1037 µg/mL (722–1353)]; p = 0.044]. There was no significant difference found for pA1M levels between the groups with and without postoperative AKI development. Haemolysis during cardiac surgery with CPB increases the risk of postoperative AKI. Levels of pA1M did not differ for patients who developed postoperative AKI compared with those who did not. The data did not allow conclusions regarding the hypothesis that pA1M has a reno-protective effect.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
alpha-1-microglobulin, Cardiac surgery, cardiopulmonary bypass, haemolysis, plasma-free haemoglobin, postoperative acute kidney injury
in
Scandinavian Journal of Clinical and Laboratory Investigation
volume
84
issue
7-8
pages
7 pages
publisher
Informa Healthcare
external identifiers
  • pmid:39729366
  • scopus:85213258112
ISSN
0036-5513
DOI
10.1080/00365513.2024.2442022
language
English
LU publication?
yes
id
709b80a7-15aa-42d1-8c8f-17bc4f4bdfc8
date added to LUP
2025-01-30 10:12:15
date last changed
2025-07-03 23:09:48
@article{709b80a7-15aa-42d1-8c8f-17bc4f4bdfc8,
  abstract     = {{<p>Haemolysis occurring during cardiac surgery with cardiopulmonary bypass (CPB) is assumed to be a risk factor for postoperative acute kidney injury (AKI). Plasma alpha-1 microglobulin (A1M) may have a protective role as haem scavenger. The aim of this study was to evaluate the association between AKI and the degree of haemolysis and the course of A1M concentrations during cardiac surgery, respectively. We analysed plasma concentrations of free haemoglobin (pfHb) and A1M in 25 patients undergoing cardiac surgery: before CPB; during CPB in 15 min intervals; after CPB; and at four additional time points until 24 h after surgery. Markers of kidney function were followed until 4 days after surgery. Detection of AKI was based on the KDIGO (Kidney Disease, Improving Global Outcome) criteria. The plasma concentration of free haemoglobin during CPB was found to be significantly higher in patients with postoperative AKI at 60 min after start of CPB [mean 1379 µg/mL (95% CI: 1037–1721)]; compared to [820 µg/mL (622–1018)]; p = 0.034, in patients without AKI, and at one hour post-CPB [2600 µg/mL (969–4230)] vs [1037 µg/mL (722–1353)]; p = 0.044]. There was no significant difference found for pA1M levels between the groups with and without postoperative AKI development. Haemolysis during cardiac surgery with CPB increases the risk of postoperative AKI. Levels of pA1M did not differ for patients who developed postoperative AKI compared with those who did not. The data did not allow conclusions regarding the hypothesis that pA1M has a reno-protective effect.</p>}},
  author       = {{Metzsch, Carsten and Lindahl, Oscar and Klarén, Martina and Grins, Edgars and Ekroth, Annika and Hansson, Stefan R. and Åkerström, Bo and Dardashti, Alain}},
  issn         = {{0036-5513}},
  keywords     = {{alpha-1-microglobulin; Cardiac surgery; cardiopulmonary bypass; haemolysis; plasma-free haemoglobin; postoperative acute kidney injury}},
  language     = {{eng}},
  number       = {{7-8}},
  pages        = {{557--563}},
  publisher    = {{Informa Healthcare}},
  series       = {{Scandinavian Journal of Clinical and Laboratory Investigation}},
  title        = {{The course of plasma alpha-1-microglobulin and haemolysis during cardiac surgery and the relationship to acute kidney injury, a pilot study}},
  url          = {{http://dx.doi.org/10.1080/00365513.2024.2442022}},
  doi          = {{10.1080/00365513.2024.2442022}},
  volume       = {{84}},
  year         = {{2024}},
}