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J Clin Anesth. 2014 Mar;26(2):118-24. doi: 10.1016/j.jclinane.2013.07.014. Epub 2014 Feb 28.

Low levels of urinary liver-type fatty acid-binding protein may indicate a lack of kidney protection during aortic arch surgery requiring hypothermic circulatory arrest.

Author information

  • 1Department of Anesthesia, Kawasaki Saiwai Hospital, 31-27 Omiya Saiwai Kawasaki, Kanagawa 212-0014, Japan. Electronic address: yosuke@mori.name.
  • 2Department of Anesthesiology, Toho University, School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo143-8540, Japan.
  • 3Department of Anesthesia, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902 Japan.

Abstract

STUDY OBJECTIVE:

To examine the change in liver-type fatty acid-binding protein (L-FABP) levels in patients undergoing aortic arch surgery and the correlation between L-FABP and postoperative acute kidney injury.

DESIGN:

Prospective observational study.

SETTING:

Operating room of a general hospital.

PATIENTS:

36 adult patients.

INTERVENTIONS AND MEASUREMENTS:

Urine samples were obtained to measure urinary L-FABP at initiation of cardiopulmonary bypass (CPB) and 5 minutes after termination of hypothermic circulatory arrest.

MAIN RESULTS:

22 (61.1%) patients developed acute kidney injury within a 48-hour period. L-FABP increases more than a thousand-fold were found. In patients who subsequently developed acute kidney injury, significant increases in L-FABP were noted from 2.9 (3.6) ng/mg of creatinine before CPB to 62.1 (995.6) ng/mg of creatinine 5 minutes after termination of circulatory arrest. Values in patients who did not develop acute kidney injury increased from 1.1 (5.7) ng/mg before CPB to 1133.0 (6358.8) ng/mg of creatinine showing a significant mean difference (P = 0.011). The area under the L-FABP receiver operating characteristic curve at 5 minutes after termination of circulatory arrest was 0.758. A cutoff value of 75.13 ng/mg of creatinine yielded both good sensitivity (1.000) and specificity (0.546) for detecting non-acute kidney injury. Patients who developed acute kidney injury after aortic arch surgery demonstrated lower levels of urinary L-FABP.

CONCLUSIONS:

Low levels of urinary L-FABP may indicate kidney injury and lack of renal protection.

Copyright © 2014 Elsevier Inc. All rights reserved.

KEYWORDS:

Acute kidney injury; Aortic arch surgery; Hypothermic circulatory arrest; L-FABP; Liver-type fatty acid-binding protein; Renal protection

[PubMed - indexed for MEDLINE]
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