Changes in serum cystatin C, creatinine, and C-reactive protein after cardiopulmonary bypass in patients with normal preoperative kidney function.
2016 (English)In: Nephrology (Carlton. Print), ISSN 1320-5358, E-ISSN 1440-1797, Vol. 21, no 6, 519-525 p.Article in journal (Refereed) Published
AIM: The use of cardiopulmonary bypass (CPB) can cause changes in serum creatinine and cystatin C independent of glomerular filtration rate. We aimed to quantify the temporal changes of these biomarkers and C-reactive protein (CRP) after CPB.
METHODS: This was a prospective study at an academic medical center between April and October 2013. We compared postoperative changes in serum creatinine and cystatin C in 38 patients with normal preoperative kidney function who underwent cardiac surgery using CPB and did not develop perioperative acute kidney injury (AKI). The effect of inflammation on intra-individual changes was examined in mixed effects regressions, using measurements of pre- and postoperative CRP.
RESULTS: Both serum creatinine (79.9 ± 22.7 vs. 92.6 ± 21.4 µmol/L, p = 0.001) and cystatin C (1.16 ± 0.39 vs. 1.33 ± 0.37 mg/L, p = 0.012) decreased significantly in the first 8 hours postoperatively compared to preoperatively, as a result of hemodilution. Thereafter serum creatinine returned to preoperative levels, whereas serum cystatin C continued to rise and was significantly elevated at 72 hours post-CPB compared to preoperative levels (1.53 ± 0.48 vs. 1.33 ± 0.37 mg/L, p = 0.003). CRP levels increased significantly post-CPB and were significantly associated with increases in both serum creatinine and cystatin C.
CONCLUSIONS: Serum creatinine and cystatin C appear not to be interchangeable biomarkers during and immediately after CPB. Processes unrelated to kidney function such as acute inflammation have a significant effect on post-CPB changes in these biomarkers, and may result in significant increases in serum cystatin C that could erroneously be interpreted as AKI. This article is protected by copyright. All rights reserved.
Place, publisher, year, edition, pages
Wiley-Blackwell, 2016. Vol. 21, no 6, 519-525 p.
Anesthesiology and Intensive Care
IdentifiersURN: urn:nbn:se:liu:diva-122030DOI: 10.1111/nep.12630ISI: 000379594600010PubMedID: 26396066OAI: oai:DiVA.org:liu-122030DiVA: diva2:861460
Funding agencies: county council of Ostergotland [LIO-205491, LIO-277491]2015-10-162015-10-162016-08-07