CAN OBESITY AND OXIDATIVE STRESS LEAD TO ACUTE KIDNEY INJURY AFTER CARDIAC SURGERY?
Keywords:
obesity, cardiopulmonary bypass, acute kidney injuryAbstract
Cardiopulmonary bypass (CPB) revolutionized cardiac surgery and contributed immensely to improved patients’ outcomes [1, 2]. It is accepted that CPB exposes patients to non-physiological conditions during which organs are subjected to severe functional alterations. These leads to activation of different coagulation, proinflammatory, survival cascades, and oxidative stress [3–5]. Despite significant development over the years, oxidative stress and inflammation remain major concern when using CPB [6, 7].
Obesity in patients undergoing cardiac surgery increases oxidative stress, endothelial dysfunction, and inflammation, [8,9] and systemic markers of these processes, including F2-isoprostanes, IL-6, and plasminogen activator inhibitor (PAI)-1, increase rapidly and probably are related with development of acute kidney injury (AKI). AKI complicates the recovery of up to 30% of patients undergoing cardiac surgery. Moreover, it promotes systemic and sternal wound infection, is associated with myocardial injury and postoperative arrhythmias, and increase in the odds of death at 30 days. [10–13]. Despite the advances in surgical techniques, anesthesia, and intensive care that led to reduced perioperative mortality and shorter duration of hospitalization, the mortality associated with AKI after cardiac surgery have increased [5]. These findings could be explained in part by the growing prevalence of obesity due to the fact that the latter is proven to be associated with higher AKI incidence [14–17].
References
Baufreton, C., Corbeau, J.-J., & Pinaud, F. (2006). “Inflammatory response and haematological disorders in cardiac surgery: toward amore physiological cardiopulmonary bypass,” Annales Francaises d’Anesthesie et de Reanimation, vol. 25, no. 5, pp. 510– 520,
Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J. (1998). Independent association between acute renal failure and mortality following cardiac surgery. Am J Med 104: 343–348,
Connern C. P., & Halestrap, A. P. (1994). “Recruitment of mitochondrial cyclophilin to the mitochondrial inner membrane under conditions of oxidative stress that enhance the opening of a calcium-sensitive non-specific channel,” The Biochemical Journal, vol. 302, part 2, pp. 321–324,
Dabbous, A., Kassas, C., & Baraka, A. (2003) . “The inflammatory response after cardiac surgery,” Middle East Journal of Anesthesiology, vol. 17, no. 2, pp. 233–254,
Daly, R. C., Dearani, J. A., McGregor, C. G. A. et al., (2005). “Fifty years of open heart surgery at theMayoClinic,”Mayo Clinic Proceedings, vol. 80, no. 5, pp. 636–640,
Druml W, Metnitz B, Schaden E, Bauer P, Metnitz PGH. (2010). Impact of body mass on incidence and prognosis of acute kidney injury requiring renal replacement therapy. Intensive Care Med 36: 1221–1228,
Edmunds, L. H. (2004). “Cardiopulmonary bypass after 50 years,” TheNew England Journal ofMedicine, vol. 351, no. 16, pp. 1603–1606,
Halestrap, A. P., Clarke, S. J., & Javadov, S. A. (2004). “Mitochondrial permeability transition pore opening during myocardial reperfusion—a target for cardioprotection,” Cardiovascular Research, vol. 61, no. 3, pp. 372–385,
Honda, H. M., Korge, P. & Weiss, J. N. (2005). “Mitochondria and ischemia/reperfusion injury,” Annals of the New York Academy of Sciences, vol. 1047, pp. 248–258,
Greenberg AS, & Obin MS (2006). Obesity and the role of adipose tissue in inflammation and metabolism. Am J Clin Nutr 83: 461S–465S
Glance LG, Wissler R, Mukamel DB, Li Y, Diachun CAB, Salloum R, Fleming FJ, Dick AW. (2010). Perioperative outcomes among patients with the modified metabolic syndrome who are undergoing noncardiac surgery. Anesthesiology 113: 859–872,
Kirklin, J. K., & McGiffin, D. C. (1987). “Early complications following cardiac surgery,” Cardiovascular Clinics, vol. 17, no. 3, pp. 321– 343
Mehta RH, Grab JD, O’Brien SM, Bridges CR, Gammie JS, Haan CK, Ferguson TB, Peterson ED. (2006). Society of Thoracic Surgeons National Cardiac Surgery Database Investigators: Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation 114: 2208–2216, quiz 2208,
Ng, C. S. H., & Wan, S. (2012). “Limiting inflammatory response to cardiopulmonary bypass: pharmaceutical strategies,” Current Opinion in Pharmacology, vol. 12, no. 2, pp. 155–159
PragaM, Hernández E, Herrero JC, Morales E, Revilla Y, Díaz-González R, Rodicio JL (2000). Influence of obesity on the appearance of proteinuria and renal insufficiency after unilateral nephrectomy. Kidney Int 58: 2111–2118,
Pasdois, P., Parker, J. E., Griffiths, E. J., & Halestrap, A. P. (2011). “The role of oxidized cytochrome
