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Yang X, Zhu L, Pan H, Yang Y. Cardiopulmonary bypass associated acute kidney injury: better understanding and better prevention. Ren Fail 2024; 46:2331062. [PMID: 38515271 PMCID: PMC10962309 DOI: 10.1080/0886022x.2024.2331062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
Cardiopulmonary bypass (CPB) is a common technique in cardiac surgery but is associated with acute kidney injury (AKI), which carries considerable morbidity and mortality. In this review, we explore the range and definition of CPB-associated AKI and discuss the possible impact of different disease recognition methods on research outcomes. Furthermore, we introduce the specialized equipment and procedural intricacies associated with CPB surgeries. Based on recent research, we discuss the potential pathogenesis of AKI that may result from CPB, including compromised perfusion and oxygenation, inflammatory activation, oxidative stress, coagulopathy, hemolysis, and endothelial damage. Finally, we explore current interventions aimed at preventing and attenuating renal impairment related to CPB, and presenting these measures from three perspectives: (1) avoiding CPB to eliminate the fundamental impact on renal function; (2) optimizing CPB by adjusting equipment parameters, optimizing surgical procedures, or using improved materials to mitigate kidney damage; (3) employing pharmacological or interventional measures targeting pathogenic factors.
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Affiliation(s)
- Xutao Yang
- The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China
| | - Li Zhu
- The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China
- The Jinhua Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Hong Pan
- The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China
| | - Yi Yang
- The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China
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Kamenshchikov NO, Podoksenov YK, Kozlov BN, Maslov LN, Mukhomedzyanov AV, Tyo MA, Boiko AM, Margolis NY, Boshchenko AA, Serebryakova ON, Dzyuman AN, Shirshin AS, Buranov SN, Selemir VD. The Nephroprotective Effect of Nitric Oxide during Extracorporeal Circulation: An Experimental Study. Biomedicines 2024; 12:1298. [PMID: 38927505 PMCID: PMC11201384 DOI: 10.3390/biomedicines12061298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/24/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
This study aims to determine the effectiveness of administering 80 ppm nitric oxide in reducing kidney injury, mitochondrial dysfunction and regulated cell death in kidneys during experimental perfusion. Twenty-four sheep were randomized into four groups: two groups received 80 ppm NO conditioning with 90 min of cardiopulmonary bypass (CPB + NO) or 90 min of CPB and hypothermic circulatory arrest (CPB + CA + NO), while two groups received sham protocols (CPB and CPB + CA). Kidney injury was assessed using laboratory (neutrophil gelatinase-associated lipocalin, an acute kidney injury biomarker) and morphological methods (morphometric histological changes in kidney biopsy specimens). A kidney biopsy was performed 60 min after weaning from mechanical perfusion. NO did not increase the concentrations of inhaled NO2 and methemoglobin significantly. The NO-conditioning groups showed less severe kidney injury and mitochondrial dysfunction, with statistical significance in the CPB + NO group and reduced tumor necrosis factor-α expression as a trigger of apoptosis and necroptosis in renal tissue in the CPB + CA + NO group compared to the CPB + CA group. The severity of mitochondrial dysfunction in renal tissue was insignificantly lower in the NO-conditioning groups. We conclude that NO administration is safe and effective at reducing kidney injury, mitochondrial dysfunction and regulated cell death in kidneys during experimental CPB.
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Affiliation(s)
- Nikolay O. Kamenshchikov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Yuri K. Podoksenov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Boris N. Kozlov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Leonid N. Maslov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Alexander V. Mukhomedzyanov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Mark A. Tyo
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Alexander M. Boiko
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Natalya Yu. Margolis
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Alla A. Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk 634012, Russia; (Y.K.P.); (B.N.K.); (L.N.M.); (A.V.M.); (M.A.T.); (A.M.B.); (N.Y.M.); (A.A.B.)
| | - Olga N. Serebryakova
- Department of Morphology and General Pathology, Siberian State Medical University, 2 Moskovsky trakt, Tomsk 634050, Russia; (O.N.S.); (A.N.D.)
| | - Anna N. Dzyuman
- Department of Morphology and General Pathology, Siberian State Medical University, 2 Moskovsky trakt, Tomsk 634050, Russia; (O.N.S.); (A.N.D.)
| | - Alexander S. Shirshin
- Federal State Unitary Enterprise “Russian Federal Nuclear Center—All-Russian Research Institute of Experimental Physics”, 37, Mira Ave., Nizhny Novgorod Region, Sarov 607190, Russia; (A.S.S.); (S.N.B.); (V.D.S.)
| | - Sergey N. Buranov
- Federal State Unitary Enterprise “Russian Federal Nuclear Center—All-Russian Research Institute of Experimental Physics”, 37, Mira Ave., Nizhny Novgorod Region, Sarov 607190, Russia; (A.S.S.); (S.N.B.); (V.D.S.)
| | - Victor D. Selemir
- Federal State Unitary Enterprise “Russian Federal Nuclear Center—All-Russian Research Institute of Experimental Physics”, 37, Mira Ave., Nizhny Novgorod Region, Sarov 607190, Russia; (A.S.S.); (S.N.B.); (V.D.S.)
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Brinkley L, Brock MA, Stinson G, Bilgili A, Jacobs JP, Bleiweis M, Peek GJ. The biological role and future therapeutic uses of nitric oxide in extracorporeal membrane oxygenation, a narrative review. Perfusion 2024:2676591241228169. [PMID: 38226651 DOI: 10.1177/02676591241228169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
BACKGROUND Nitric oxide (NO) is a gas naturally produced by the human body that plays an important physiological role. Specifically, it binds guanylyl cyclase to induce smooth muscle relaxation. NO's other protective functions have been well documented, particularly its protective endothelial functions, effects on decreasing pulmonary vascular resistance, antiplatelet, and anticoagulation properties. The use of nitric oxide donors as vasodilators has been known since 1876. Inhaled nitric oxide has been used as a pulmonary vasodilator and to improve ventilation perfusion matching since the 1990s. It is currently approved by the United States Food and Drug Administration for neonates with hypoxic respiratory failure, however, it is used off-label for acute respiratory distress syndrome, acute bronchiolitis, and COVID-19. PURPOSE In this article we review the currently understood biological action and therapeutic uses of NO through nitric oxide donors such as inhaled nitric oxide. We will then explore recent studies describing use of NO in cardiopulmonary bypass and extracorporeal membrane oxygenation and speculate on NO's future uses.
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Clark JB. Commentary: Encouraging findings for the renal-protective effect of nitric oxide administration during cardiopulmonary bypass. J Thorac Cardiovasc Surg 2023; 166:e176-e177. [PMID: 37164057 DOI: 10.1016/j.jtcvs.2023.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Joseph B Clark
- Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pa.
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