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Perfusion
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Increase in plasma free haemoglobin during cardiopulmonary bypass in heart valve surgery: assessment of renal dysfunction by RIFLE classification

T. Vanek

Department of Cardiac Surgery, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Czech Republic, vanek{at}fnkv.cz

J. Snircova

Department of Cardiac Surgery, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Czech Republic

J. Spegar

Department of Cardiac Surgery, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Czech Republic

Z. Straka

Department of Cardiac Surgery, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Czech Republic

J. Horak

Blood Establishment and Blood Bank, University Hospital Kralovske Vinohrady, Czech Republic

M. Maly

Department of Scientific Information and Biostatistics, Centre of Public Health Protection and Promotion, National Institute of Public Health, Prague, Czech Republic

Heart valve surgery carries a high risk of renal insufficiency as an independent risk factor due to prolonged cardiopulmonary bypass. Multiple causes of cardiopulmonary bypass-associated renal damage have been described, and haemoglobin-induced renal injury is presently being investigated. Forty-three patients scheduled for heart valve surgery (mostly combined) were enrolled in the prospective study. Plasma free haemoglobin (PFH) levels were evaluated by photocolorimetric measurement at the start of procedures (t0) and before the end of extracorporeal circulation (t1). A statistically significant increase in PFH levels during cardiopulmonary bypass was detected [median values (interquartile range) - t0: 62.0 (53.4) mg/L, t1: 320.4 (352.2) mg/L], P < 0.001. A significant regression relationship between the duration of cardiopulmonary bypass and the increased PFH was found (Spearman’s correlation coefficient 0.628, P < 0.001). In some elderly patients, the tendency towards a high release of PFH during cardiopulmonary bypass was more pronounced, but the overall association between age and PFH levels was of borderline significance (P = 0.077). The correlation between PFH and post-operative serum creatinine was low and non-significant, but the latter correlated highly with the pre-operative serum creatinine values (Spearman’s correlation coefficient reached values of 0.6-0.7, P < 0.001). Patients were classified according to the Risk of renal failure, Injury to the kidney, Failure of kidney function, Loss of kidney function and End-stage renal failure (RIFLE) classification for acute renal dysfunction during post-operative days 1 — 4; the influence of PFH levels at t1 on the consequent RIFLE classification was not proven (P=0.648), but 4 patients in the Injury category had shown a higher median value of PFH (433.6 mg/L) in comparison with the others (29 patients with no acute renal dysfunction - 313.7 mg/L, 10 patients at Risk - 330.1 mg/L).

Key Words: plasma free haemoglobin • kidney function • acute renal failure • cardiopulmonary bypass • heart valve surgery.

This version was published on May 1, 2009

Perfusion, Vol. 24, No. 3, 179-183 (2009)
DOI: 10.1177/0267659109350400
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