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Cardiopulmonary bypass (CPB) during cardiac surgeries is known to often result in kidney dysfunction, contributing to increased morbidity and mortality. This study aimed to evaluate the impact of CPB on kidney structures in patients undergoing cardiac surgery, utilizing serum and urinary biomarkers.
This prospective study involved patients who underwent cardiac surgery between August 2021 and October 2022. We collected variables related to clinical and surgical aspects, along with laboratory data. Glomerular filtration rate was estimated using the CKD-EPI equation. Urinary biomarkers included nephrin, NGAL, MCP-1, and KIM-1. Serum NGAL and the glycocalyx endothelial biomarker syndecan-1 were also assessed.
A total of 22 patients were enrolled, with an average age of 65 ± 8 years, and 68% were male. Statistical analysis showed no significant differences in most clinical aspects between groups, regardless of the use of CPB during cardiac surgery. However, patients in the CPB group exhibited elevated levels of urinary nephrin (2051.42 [1018.82 - 4166.25] vs. 400 [27.59 - 1186.9] pg/mg-Cr, p=0.007), urinary NGAL (24 [13.28 - 31.58] vs. 7.24 [4.55 - 14.18] ng/mg-Cr, p=0.036), and serum NGAL (282.12 [232.5 - 312.25] vs. 165.15 [126.16 - 186.42] ng/mL, p=0.030) during cardiac surgery. Furthermore, elevated urinary NGAL levels in CPB patients during surgery were correlated with a decline in glomerular filtration rate within the first 48 hours after cardiac surgery (Rho= -0.838, p=0.009).
The use of CPB during cardiac surgery is associated with significant impacts on kidney structure, leading to podocyte and tubular injury and compromised kidney function in the short term