Evaluation of Cystatin C as a marker of renal injury following on-pump and off-pump coronary surgery

Abu-Omar, Yasir; Mussa, Shafi; Naik, Madhava J.; MacCarthy, Noel; Standing, Sue; Taggart, David P.
May 2005
European Journal of Cardio-Thoracic Surgery;May2005, Vol. 27 Issue 5, p893
Academic Journal
Abstract: Objective: Cardiopulmonary bypass is regarded as an important contributor to renal injury, whereas off-pump surgery is considered less damaging. Cystatin C, a cystine protease inhibitor, is more sensitive and specific than creatinine in the assessment of renal function. We assessed the value of Cystatin C in quantifying clinical and subclinical renal injury following on-pump and off-pump cardiac surgery. Methods: Sixty consecutive patients were recruited: 30 patients undergoing on-pump CABG and 30 patients undergoing off-pump CABG. Blood samples were collected pre-operatively and on days 1, 2 and 4 postoperatively to measure serum creatinine and serum Cystatin C. Urinary samples were collected concurrently to measure microalbumin and N-acetyl-β-glucosaminidase, denoting changes in renal glomerular and tubular function respectively. Results: The off-pump group were older (65±11 vs. 61±8 years; P=0.046), had a higher mean Parsonnet score (9.4±6.2 vs. 5.4±3.6, P<0.01) and received fewer grafts (2.4±0.9 vs. 3.1±0.7; P<0.01) compared to the on-pump group. The groups were otherwise matched with respect to preoperative renal function and left ventricular function. Patients undergoing on-pump CABG had greater increases in all four parameters of renal injury. Adjustment for preoperative differences increased the size and significance of the effect of off-pump vs. on-pump surgery (percent difference 13%; 95% CI 2–26 for creatinine, and 16%; 95% CI 4–29 for Cystatin C). Cystatin and creatinine were strongly correlated with each other. Conclusions: Avoidance of cardiopulmonary bypass may reduce renal injury particularly in higher risk patients. Cystatin C proved to be a simple and sensitive measure of overall renal function and can be used in the routine assessment of renoprotective strategies.


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