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      Does acute normovolemic hemodilution affect intraoperative value of serum-creatinine concentration in patients undergoing cardiac surgery

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      https://www.riss.kr/link?id=A103548595

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      다국어 초록 (Multilingual Abstract)

      Background: The possible impact of hemodilution during acute normovolemic hemodilution (ANH) using hydroxyethyl starch (HES) on intraoperative serum concentration of creatinine (s-Cr) has not been well investigated.
      Methods: Patients undergoing cardiac surgery were randomly allocated into Group-ANH (n = 15) or Group-C (control; n = 17).
      In Group-ANH, 5 ml/kg whole blood was collected, and they were administered 5 ml/kg of HES 130/0.4 after anesthesia induction and before initiating cardiopulmonary bypass (CPB). In both groups, moderate hypothermic CPB was initiated using 1,600–1,800 ml of bloodless priming solution. The changes of s-Cr, blood urea nitrogen, hematocrit (Hct), electrolytes, and osmolality were determined before ANH administration (T1), after administering ANH 5 ml/kg (T2), 30 and 60 s after the initiation of CPB (T3, T4), and at the end of surgery (T5).
      Results: In Group-ANH, the s-Cr values at T2 (median [IQR25– 75%], 0.83 [0.71–1.00] mg/dl) were not significantly different compared to those at T1 (0.84 [0.64–1.00] mg/dl), while those at T3 and T4 (0.68 [0.61–0.80] and 0.76 [0.59–0.92] mg/dl, respectively) were significantly lower than those at T2 (0.83 [0.71–1.00] mg/dl, P < 0.001). Hct at T3, T4 and T5 were significantly lower than those of T1 in both groups, and those at T2 and T4 of Group-ANH were significantly lower than those of Group-C (P < 0.001). There was no significant inter-group difference in all other parameters.
      Conclusions: Intraoperative s-Cr was not affected by the administration of ANH 5 ml/kg, although it reduced transiently at the beginning of CPB. Further study is needed to determine the clinical relevancy of our results.
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      Background: The possible impact of hemodilution during acute normovolemic hemodilution (ANH) using hydroxyethyl starch (HES) on intraoperative serum concentration of creatinine (s-Cr) has not been well investigated. Methods: Patients undergoing cardia...

      Background: The possible impact of hemodilution during acute normovolemic hemodilution (ANH) using hydroxyethyl starch (HES) on intraoperative serum concentration of creatinine (s-Cr) has not been well investigated.
      Methods: Patients undergoing cardiac surgery were randomly allocated into Group-ANH (n = 15) or Group-C (control; n = 17).
      In Group-ANH, 5 ml/kg whole blood was collected, and they were administered 5 ml/kg of HES 130/0.4 after anesthesia induction and before initiating cardiopulmonary bypass (CPB). In both groups, moderate hypothermic CPB was initiated using 1,600–1,800 ml of bloodless priming solution. The changes of s-Cr, blood urea nitrogen, hematocrit (Hct), electrolytes, and osmolality were determined before ANH administration (T1), after administering ANH 5 ml/kg (T2), 30 and 60 s after the initiation of CPB (T3, T4), and at the end of surgery (T5).
      Results: In Group-ANH, the s-Cr values at T2 (median [IQR25– 75%], 0.83 [0.71–1.00] mg/dl) were not significantly different compared to those at T1 (0.84 [0.64–1.00] mg/dl), while those at T3 and T4 (0.68 [0.61–0.80] and 0.76 [0.59–0.92] mg/dl, respectively) were significantly lower than those at T2 (0.83 [0.71–1.00] mg/dl, P < 0.001). Hct at T3, T4 and T5 were significantly lower than those of T1 in both groups, and those at T2 and T4 of Group-ANH were significantly lower than those of Group-C (P < 0.001). There was no significant inter-group difference in all other parameters.
      Conclusions: Intraoperative s-Cr was not affected by the administration of ANH 5 ml/kg, although it reduced transiently at the beginning of CPB. Further study is needed to determine the clinical relevancy of our results.

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      참고문헌 (Reference)

      1 정화성, "체외순환 없는 관상동맥 우회술에서 혈청 크레아티닌과 트로포닌 I의 관계" 대한마취통증의학회 4 (4): 124-128, 2009

      2 이은호, "심장 수술에서 급성신장손상" 대한마취통증의학회 11 (11): 225-235, 2016

      3 Swaminathan M, "The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery" 76 : 784-791, 2003

      4 Parolari A, "Risk factors for perioperative acute kidney injury after adult cardiac surgery : role of perioperative management" 93 : 584-591, 2012

      5 Mangano CM, "Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization" 128 : 194-203, 1998

      6 Cockcroft DW, "Prediction of creatinine clearance from serum creatinine" 16 : 31-41, 1976

      7 Edwards KD, "Plasma creatinine level and creatinine clearance as tests of renal function" 8 : 218-224, 1959

      8 Bennett SR, "Perioperative autologous blood transfusion in elective total hip prosthesis operations" 76 : 95-98, 1994

      9 Stafford-Smith M, "Perioperative Organ Protection" Society of Cardiovascular Anesthesiologists 89-124, 2003

      10 Akcan-Arikan A, "Modified RIFLE criteria in critically ill children with acute kidney injury" 71 : 1028-1035, 2007

      1 정화성, "체외순환 없는 관상동맥 우회술에서 혈청 크레아티닌과 트로포닌 I의 관계" 대한마취통증의학회 4 (4): 124-128, 2009

      2 이은호, "심장 수술에서 급성신장손상" 대한마취통증의학회 11 (11): 225-235, 2016

      3 Swaminathan M, "The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery" 76 : 784-791, 2003

      4 Parolari A, "Risk factors for perioperative acute kidney injury after adult cardiac surgery : role of perioperative management" 93 : 584-591, 2012

      5 Mangano CM, "Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization" 128 : 194-203, 1998

      6 Cockcroft DW, "Prediction of creatinine clearance from serum creatinine" 16 : 31-41, 1976

      7 Edwards KD, "Plasma creatinine level and creatinine clearance as tests of renal function" 8 : 218-224, 1959

      8 Bennett SR, "Perioperative autologous blood transfusion in elective total hip prosthesis operations" 76 : 95-98, 1994

      9 Stafford-Smith M, "Perioperative Organ Protection" Society of Cardiovascular Anesthesiologists 89-124, 2003

      10 Akcan-Arikan A, "Modified RIFLE criteria in critically ill children with acute kidney injury" 71 : 1028-1035, 2007

      11 Lassnigg A, "Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery : a prospective cohort study" 15 : 1597-1605, 2004

      12 Bojan M, "Limitations of early serum creatinine variations for the assessment of kidney injury in neonates and infants with cardiac surgery" 8 : e79308-, 2013

      13 Lassnigg A, "Impact of minimal increases in serum creatinine on outcome in patients after cardiothoracic surgery: do we have to revise current definitions of acute renal failure?" 36 : 1129-1137, 2008

      14 Berg KS, "How can we best predict acute kidney injury following cardiac surgery? : a prospective observational study" 30 : 704-712, 2013

      15 Gross JB, "Estimating allowable blood loss : corrected for dilution" 58 : 277-280, 1983

      16 Waikar SS, "Diagnosis, epidemiology and outcomes of acute kidney injury" 3 : 844-861, 2008

      17 Kumar AB, "Association between postoperative acute kidney injury and duration of cardiopulmonary bypass : a meta-analysis" 26 : 64-69, 2012

      18 Bellomo R, "Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group" 8 : R204-R212, 2004

      19 Bennett J, "Acute normovolemic hemodilution in moderate blood loss surgery : a randomized controlled trial" 46 : 1097-1103, 2006

      20 Chertow GM, "Acute kidney injury, mortality, length of stay, and costs in hospitalized patients" 16 : 3365-3370, 2005

      21 Rosner MH, "Acute kidney injury associated with cardiac surgery" 1 : 19-32, 2006

      22 Mehta RL, "Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury" 11 : R31-, 2007

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      2013-01-01 평가 등재후보학술지 유지 (기타) KCI등재후보
      2012-01-01 평가 등재후보학술지 유지 (기타) KCI등재후보
      2011-01-01 평가 등재후보 1차 PASS (등재후보1차) KCI등재후보
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      기준연도 WOS-KCI 통합IF(2년) KCIF(2년) KCIF(3년)
      2016 0.13 0.13 0.12
      KCIF(4년) KCIF(5년) 중심성지수(3년) 즉시성지수
      0.13 0.13 0.279 0.04
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