Oxidative Stress after on-Pump Cardiac Surgery in Patients with Preoperative Renal Dysfunction
DOI:
https://doi.org/10.59958/hsf.6997Keywords:
renal dysfunction, lipid peroxidation, malondialdehyde, cardiopulmonary bypassAbstract
Background: Renal dysfunction is a global health burden with a rising prevalence and increased morbidity and mortality. Since the complex and multifactorial pathophysiology of this disease and its consequences is not entirely understood, novel mechanisms are currently under investigation, one being oxidative stress. Malondialdehyde is a product of lipid peroxidation and has been widely utilised as an indirect biomarker of oxidative stress. The aim of this study was to investigate the perioperative oxidative stress in patients with preoperative renal dysfunction undergoing on-pump cardiac surgery. Methods: In 115 patients scheduled for on-pump cardiac surgery, serum concentrations of malondialdehyde were obtained pre-, intra- and postoperatively. The patients were enrolled into two study groups regarding their preoperative renal function, and the malondialdehyde concentrations were compared between the study groups. Results: Patients with preoperative renal dysfunction were older and had a higher mean EuroSCORE II score. On postoperative days 1, 2 and 3, the serum malondialdehyde levels were significantly higher in patients with preoperative renal dysfunction compared to those with normal kidney function. Using regression analysis, preoperative renal dysfunction was shown to be an independent predictor of higher postoperative malondialdehyde levels at all tested time points. Conclusions: In a pioneering study correlating cardiopulmonary bypass and oxidative stress biomarker malondialdehyde, patients with preoperative renal dysfunction were found to exhibit more pronounced and prolonged oxidative stress resulting in protracted lipid peroxidation in the early postoperative period compared to patients with normal kidney function.
References
Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney International. 2005; 67: 2089–2100.
Antonic, M. Preoperative renal dysfunction is a predictor of postoperative atrial fibrillation in coronary artery bypass patients. Acta Medico-Biotechnica. 2019; 12: 29–38.
Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation. 1998; 32: S112–S119.
Podkowińska A, Formanowicz D. Chronic Kidney Disease as Oxidative Stress- and Inflammatory-Mediated Cardiovascular Disease. Antioxidants (Basel, Switzerland). 2020; 9: 752.
Srivastava A, Kaze AD, McMullan CJ, Isakova T, Waikar SS. Uric Acid and the Risks of Kidney Failure and Death in Individuals With CKD. American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation. 2018; 71: 362–370.
Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. Journal of the American College of Cardiology. 2008; 52: 1527–1539.
Djordjević A, Šušak S, Velicki L, Antonič M. ACUTE KIDNEY INJURY AFTER OPEN-HEART SURGERY PROCEDURES. Acta Clinica Croatica. 2021; 60: 120–126.
Kao MPC, Ang DSC, Pall A, Struthers AD. Oxidative stress in renal dysfunction: mechanisms, clinical sequelae and therapeutic options. Journal of Human Hypertension. 2010; 24: 1–8.
Modaresi A, Nafar M, Sahraei Z. Oxidative stress in chronic kidney disease. Iranian Journal of Kidney Diseases. 2015; 9: 165–179.
Luczak M, Formanowicz D, Pawliczak E, Wanic-Kossowska M, Wykretowicz A, Figlerowicz M. Chronic kidney disease-related atherosclerosis - proteomic studies of blood plasma. Proteome Science. 2011; 9: 25.
Barrera G, Pizzimenti S, Daga M, Dianzani C, Arcaro A, Cetrangolo GP, et al. Lipid Peroxidation-Derived Aldehydes, 4-Hydroxynonenal and Malondialdehyde in Aging-Related Disorders. Antioxidants (Basel, Switzerland). 2018; 7: 102.
Djordjević A, Kotnik P, Horvat D, Knez Ž, Antonič M. Pharmacodynamics of malondialdehyde as indirect oxidative stress marker after arrested-heart cardiopulmonary bypass surgery. Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie. 2020; 132: 110877.
Zhang WR, Garg AX, Coca SG, Devereaux PJ, Eikelboom J, Kavsak P, et al. Plasma IL-6 and IL-10 Concentrations Predict AKI and Long-Term Mortality in Adults after Cardiac Surgery. Journal of the American Society of Nephrology: JASN. 2015; 26: 3123–3132.
Vermeulen Windsant IC, de Wit NCJ, Sertorio JTC, van Bijnen AA, Ganushchak YM, Heijmans JH, et al. Hemolysis during cardiac surgery is associated with increased intravascular nitric oxide consumption and perioperative kidney and intestinal tissue damage. Frontiers in Physiology. 2014; 5: 340.
Tracz MJ, Alam J, Nath KA. Physiology and pathophysiology of heme: implications for kidney disease. Journal of the American Society of Nephrology: JASN. 2007; 18: 414–420.
Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Annals of Internal Medicine. 1999; 130: 461–470.
Daenen K, Andries A, Mekahli D, Van Schepdael A, Jouret F, Bammens B. Oxidative stress in chronic kidney disease. Pediatric Nephrology (Berlin, Germany). 2019; 34: 975–991.
Leyane TS, Jere SW, Houreld NN. Oxidative Stress in Ageing and Chronic Degenerative Pathologies: Molecular Mechanisms Involved in Counteracting Oxidative Stress and Chronic Inflammation. International Journal of Molecular Sciences. 2022; 23: 7273.
Djordjevic A, Susak S, Kotnik P, Gorenjak M, Knez Z, Antonic M. Effect of Ascorbic Acid on Cardiac Surgery-Associated Acute Kidney Injury Incidence. The Thoracic and Cardiovascular Surgeon. 2022; 70: 566–574.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Annals of Internal Medicine. 2009; 150: 604–612.
Mosa OF, Skitek M, Kalisnik JM, Jerin A. Evaluation of serum cysteine-rich protein 61 and cystatin C levels for assessment of acute kidney injury after cardiac surgery. Renal Failure. 2016; 38: 699–705.
Jerin A, Mosa OF, Kališnik JM, Žibert J, Skitek M. Serum Klotho as a marker for early diagnosis of acute kidney injury after cardiac surgery. Journal of Medical Biochemistry. 2020; 39: 133–139.
