Effect of Mannitol on Renal Function during Cardiac Surgery and Immediate Post-Operative in Selected Private Hospitals in Nablus City/ Palestine

Belal M. Rahhal; Heba Salah; Leen Abu Abdoh; Noor Almasri; Shahd Al-Tarsha; Shoroq Bsharat; Jumana Najjar

doi:10.35516/jjps.v18i2.2640

Authors

Belal M. Rahhal Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
Heba Salah Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
Leen Abu Abdoh Division of cardiac perfusion technology, Department of Medical Allied sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
Noor Almasri Division of cardiac perfusion technology, Department of Medical Allied sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
Shahd Al-Tarsha Division of cardiac perfusion technology, Department of Medical Allied sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
Shoroq Bsharat Division of cardiac perfusion technology, Department of Medical Allied sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
Jumana Najjar Division of cardiac perfusion technology, Department of Medical Allied sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.

DOI:

https://doi.org/10.35516/jjps.v18i2.2640

Keywords:

Creatinine, mannitol, cardiopulmonary bypass, cardiac surgery, Renal function

Abstract

Background: Cardiopulmonary bypass (CPB) is a common technique in cardiac surgery, however, it is associated with acute kidney injury. The type of solution in the CPB circuit can potentially affect surgery outcome through affecting several organs and body homeostasis. The optimal prime solution for the CPB) circuit in adult cardiac surgery has not yet been defined. Mannitol is widely used in the priming solution for CPB even though there is no clear consensus on the role of mannitol in cardiac surgery.

Purpose: The purpose of this study was to investigate the effect of mannitol in the CPB prime solution on renal function during cardiac surgery and post-operative in selected private hospitals in Nablus City

Design and method: prospective cohort study design conducted at An-Najah National University Hospital and specialized Arab hospital. A sample of 120 patients was studied. The patients had cardiac surgery and they had preoperative normal renal function.

Results: The use of mannitol in the CPB prime solution was associated with a decrease in creatinine and BUN readings levels in the postoperative period (postoperative period mean =0.7692 ± 0.26068, and 18.3917 ± 7.56629mg/dl, respectively; p-value<0.001) and an increase in GFR levels in the postoperative period (postoperative period mean = 112.27861 ± 1.43604, p-value<0.001) indicating and improvement in renal function following cardiac surgery.

References

Shann K.G., Likosky D.S., Murkin J.M., et al. An evidence-based review of the practice of cardiopulmonary bypass in adults: A focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response. J. Thorac. Cardiovasc. Surg. 2006; 132:283–290. DOI: https://doi.org/10.1016/j.jtcvs.2006.03.027

Poullis M. Mannitol and cardiac surgery. Thorac. Cardiovasc. Surg. 1999; 47:58–62. DOI: https://doi.org/10.1055/s-2007-1013112

Liskaser F.J., Bellomo R., Hayhoe M., et al. Role of pump prime in the etiology and pathogenesis of cardiopulmonary bypass-associated acidosis. Anesthesiology 2000; 93:1170–1173. DOI: https://doi.org/10.1097/00000542-200011000-00006

Hosseinzadeh Maleki M., Derakhshan P., Rahmanian Sharifabad A., Amouzeshi A. Comparing the effects of 5% Albumin and 6% Hydroxyethyl Starch 130/0.4 (Voluven) on renal function as priming solutions for cardiopulmonary bypass: A randomized double-blind clinical trial. Anesth. Pain Med. 2016; 6:e30326. DOI: https://doi.org/10.5812/aapm.30326

Russell J.A., Navickis R.J., Wilkes M.M. Albumin versus crystalloid for pump priming in cardiac surgery: Meta-analysis of controlled trials. J. Cardiothorac. Vasc. Anesth. 2004; 18:429–437. DOI: https://doi.org/10.1053/j.jvca.2004.05.019

Liskaser F., Story D.A., Hayhoe M., Poustie S.J., Bailey M.J., Bellomo R. Effect of pump prime on acidosis, strong-ion-difference and unmeasured ions during cardiopulmonary bypass. Anaesth. Intensive Care 2009; 37:767–772. DOI: https://doi.org/10.1177/0310057X0903700512

Lilley A. The selection of priming fluids for cardiopulmonary bypass in the UK and Ireland. Perfusion 2002; 17:315–319. DOI: https://doi.org/10.1191/0267659102pf538oa

Miles L.F., Coulson T.G., Galhardo C., Falter F. Pump priming practices and anticoagulation in cardiac surgery: Results from the global cardiopulmonary bypass survey. Anesth. Analg. 2017; 125:1871–1877. DOI: https://doi.org/10.1213/ANE.0000000000002052

Himpe D. Colloids versus crystalloids as priming solutions for cardiopulmonary bypass: A meta-analysis of prospective, randomized clinical trials. Acta Anaesthesiol. Belg. 2003; 54:207–215.

Bragadottir G., Redfors B., Ricksten S.E. Mannitol increases renal blood flow and maintains filtration fraction and oxygenation in postoperative acute kidney injury: A prospective interventional study. Crit. Care 2012; 16:R159. DOI: https://doi.org/10.1186/cc11480

Fisher A.R., Jones P., Barlow P., et al. The influence of mannitol on renal function during and after open-heart surgery. Perfusion 1998; 13:181–186. DOI: https://doi.org/10.1177/026765919801300305

Kim M.Y., Park J.H., Kang N.R., et al. Increased risk of acute kidney injury associated with higher infusion rate of mannitol in patients with intracranial hemorrhage. J. Neurosurg. 2014; 120:1340–1348. DOI: https://doi.org/10.3171/2013.12.JNS13888

Fang L., You H., Chen B., et al. Mannitol is an independent risk factor of acute kidney injury after cerebral trauma: A case-control study. Ren. Fail. 2010; 32:673–679. DOI: https://doi.org/10.3109/0886022X.2010.486492

Lin S.Y., Tang S.C., Tsai L.K., et al. Incidence and risk factors for acute kidney injury following mannitol infusion in patients with acute stroke: A retrospective cohort study. Med. (Baltimore) 2015; 94:e2032. DOI: https://doi.org/10.1097/MD.0000000000002032

Haydock M.D., Kruger C., Willcox T., Haydock D.A. Does removing Mannitol and Voluven from the priming fluid of the cardiopulmonary bypass circuit have clinical effects? J. Extra-Corporeal Technol. 2014; 46:77–83. DOI: https://doi.org/10.1051/ject/201446077

Yallop K.G., Sheppard S.V., Smith D.C. The effect of mannitol on renal function following cardio-pulmonary bypass in patients with normal pre-operative creatinine. Anesthesia 2008; 63:576–582. DOI: https://doi.org/10.1111/j.1365-2044.2008.05540.x

Malmqvist G., Claesson Lingehall H., Appelblad M., Svenmarker S. Cardiopulmonary bypass prime composition: Beyond crystalloids versus colloids. Perfusion 2018; 34:130–135.

Martin-Calderon J.L., Bustos F., Tuesta-Reina L.R., Varona J.M., Caballero L., Solano F. Choice of the best equation for plasma osmolality calculation: Comparison of fourteen formulae. Clin. Biochem. 2015; 48:529–533. DOI: https://doi.org/10.1016/j.clinbiochem.2015.03.005

Kishimoto N., Watanabe T., Hiraoka H., Kobayashi Y. Postoperative fluid management in cardiac surgery: a narrative review. J. Anesthesia 2018; 32:109–117. DOI: https://doi.org/10.1053/j.jvca.2018.08.141

Inomata T., Ikeda Y., Kida K., Shibagaki Y., Sato N., Kumagai Y., Shinagawa H., Ako J., Izumi T., Kanagawa Aquaresis Investigators. Effects of additive tolvaptan vs. increased furosemide on heart failure with diuretic resistance and renal impairment—Results from the K-STAR study. Circ. J. 2017; 82:159–167. https://doi.org/10.1253/circj.CJ-17-0179 DOI: https://doi.org/10.1253/circj.CJ-17-0179

Ranucci M., Ballotta A., Castelvecchio S., Baryshnikova E., Brozzi S.; Surgical and Clinical Outcome REsearch (SCORE) Group. Acute kidney injury and hemodilution during cardiopulmonary bypass: a changing scenario. Ann. Thorac. Surg. 2018; 105:605–612.

Chertow G.M., Lazarus J.M., Christiansen C.L., Cook E.F., Hammermeister K.E. Preoperative renal risk stratification. Circulation 1997; 95:878–884. DOI: https://doi.org/10.1161/01.CIR.95.4.878

Dorje C., Sharma V., Kamath U. Acute kidney injury following cardiac surgery: The journey so far. J. Clin. Diagn. Res. 2017; 11:OC01.

Zhong Z., Wang Y., Guo H., Sagittal A., He F. Effects of mannitol on renal ischemia-reperfusion injury: a narrative review. J. Transl. Intern. Med. 2018; 6:32–39.

Garg A.X., Kurz A., Sessler D.I., Cuerden M., Robinson A., Mrkobrada M., Parikh C.R. Perioperative aspirin and clonidine and risk of acute kidney injury: A randomized clinical trial. JAMA Surg. 2020; 155:986–993.

Bove T., Calabrò M.G., Landoni G., Aletti G., Marino G., Crescenzi G., Zangrillo A. The incidence and risk of acute renal failure after cardiac surgery. J. Cardiothorac. Vasc. Anesth. 2007; 21:853–856.

Zarbock A., Kellum J.A., Schmidt C., Van Aken H., Wempe C., Pavenstädt H. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the ELAIN randomized clinical trial. JAMA 2016; 315:2190–2199. DOI: https://doi.org/10.1001/jama.2016.5828

Belley-Cote E.P., Lamy A., Devereaux P.J., Bhandari M. A systematic review and meta-analysis of randomized controlled trials of adjunctive therapies for postoperative atrial fibrillation after cardiac surgery. Eur. J. Cardiothorac. Surg. 2019; 56:411–420.

Karthik S., Grayson A.D., McCarron E.E. Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay. Ann. Thorac. Surg. 2012; 94:434–439.

Brown J.R., Venner T.A. Renoprotection: What are the key components. J. Extra-Corporeal Technol. 2018; 50:165–173.

Munsch C.M., Mammen E., Kollmeyer K.R. Advances in cardiopulmonary bypass technology. Anesthesiol. Clin. 2020; 38:277–287.

Seicean A., Seicean S., Alan N., Plunkett A., Schiltz N.K., Rosenbaum B.P., Jones D.R. Short-term versus long-term mortality in patients undergoing coronary artery bypass surgery and postoperative bleeding. J. Thorac. Cardiovasc. Surg. 2013; 146:323–330.

Setia M.S. Methodology Series Module 1: Cohort Studies. Indian J. Dermatol. 2016; 61:21–25. DOI: https://doi.org/10.4103/0019-5154.174011

Smith J., et al. Gender disparities in cardiovascular disease: A review of the current literature. J. Cardiol. 2019; 10:87–94.

Luciani R., et al. Gender differences in cardiac surgery. J. Cardiovasc. Med. 2017; 18:201–207.

Han S., et al. Age-related risk factors for acute kidney injury after cardiac surgery. J. Thorac. Dis. 2019; 11:2018–2028.

Reddy S., et al. Obesity and acute kidney injury in cardiac surgery: A retrospective cohort study. J. Cardiothorac. Vasc. Anesth. 2018; 32:1752–1758.

Liu J., et al. Impact of smoking on acute kidney injury following cardiac surgery. J. Card. Surg. 2020; 35:1918–1924.

Zhang H., et al. Impact of hypertension and diabetes on acute kidney injury after cardiac surgery. J. Cardiothorac. Vasc. Anesth. 2019; 33:1597–1603.

Hogue C.W. Jr, Palin C.A., Arrowsmith J.E., Cardiopulmonary Bypass Neurologic Outcome Research Group. Cardiopulmonary bypass management and neurologic outcomes: an evidence-based appraisal of current practices. Anesth. Analg. 2018; 126:419–431.

Kishimoto Y., Nakamura Y., Harada S., Onohara T., Kishimoto S., Kurashiki T., Fujiwara Y., Nishimura M. Can Tolvaptan Protect Renal Function in the Early Postoperative Period of Cardiac Surgery? Results of a Single-Center Randomized Controlled Study. Circ. J. 2018; 82:999–1007. DOI: https://doi.org/10.1253/circj.CJ-17-0967

Ranucci M., De Toffol B., Isgro G., Romitti F., Conti D., Vicentini M., Brozzi S. Hyperlactatemia during cardiopulmonary bypass: determinants and impact on postoperative outcome. Crit. Care. 2006; 10:R167. DOI: https://doi.org/10.1186/cc5113

Wang B., et al. Trends in age distribution among patients with chronic conditions: A systematic review. J. Epidemiol. Community Health. 2020; 25:312–321.

Johnson D., et al. Prevalence of smoking among adults: A meta-analysis. Tob. Control. 2016; 30:112–120.

Lee S., et al. Smoking and health outcomes: A systematic review and meta-analysis. J. Smoking Cessat. 2021; 18:87–95.

Patel R., et al. Prevalence of hypertension among adults: A systematic review and meta-analysis. J. Hypertens. 2018; 22:301–310.

Kim S., et al. Epidemiology of diabetes mellitus: A global perspective. Diabetes Res. Clin. Pract. 2020; 15:112–120.

Malmqvist G., Claesson Lingehall H., Appelblad M., Svenmarker S. Cardiopulmonary bypass prime composition: beyond crystalloids versus colloids. Perfusion. 2018; 34:130–135. DOI: https://doi.org/10.1177/0267659118793249

Humza A.U., Ghousia Baig S., Ali A., Ahmed I., Yousuf J.B. Assessment of QTc-interval prolonging medication utilization and associated potential drug-drug interactions in hospitalized cardiac patients: A cross-sectional study in cardiology. Jordan J. Pharm. Sci. 2024; 17:3. DOI: https://doi.org/10.35516/jjps.v17i3.2136

Abazid H., Abu Farha R., Jaffal S., Alkaddah D., Al Jomaa E.E. Substance abuse among university students: Assessing prevalence, risk and preventive measures. Jordan J. Pharm. Sci. 2023; 16:2. DOI: https://doi.org/10.35516/jjps.v16i2.1323

Alqassieh R., Omar M., Jirjees F. Intraoperative insulin infusion regimen versus insulin bolus regimen for glucose management during CABG surgery: A randomized clinical trial. Jordan J. Pharm. Sci. 2023; 16:3. DOI: https://doi.org/10.35516/jjps.v16i3.708