国際心臓血管研究ジャーナル

Discontinuation of Renine Angiotensine Aldosterone Blockade System did not reduced Post Coronary Surgery Renal Failure

Juan Manuel Lange, Jorge Isaac Parras, Romina Laurino and Julio Marini, Susana De Tournemine

Discontinuation of Renine Angiotensine Aldosterone Blockade System did not reduced Post Coronary Surgery Renal Failure

Objective: To evaluate if preoperative discontinuation reninangiotensin- aldosterone blockade system (RAABS) reduces postoperative acute renal failure incidence in patients undergoing on or off pump coronary artery bypass grafting.

Design: Prospective, double blind, randomized study.

Setting: Single center study made in a tertiary cardiovascular care facility.

Participants: Patients with at least one month of renin-angiotensinaldosterone blockade system treatment, scheduled for coronary artery bypass surgery were included. Patients with cardiogenic shock, acute or end stage chronic renal disease, acute coronary syndrome, hypertension development due to treatment suspension, acute heart failure or increased functional class of chronic heart failure within last 30 days were excluded.

Interventions: Patients were randomized in two groups: a) 72 hours RAABS suspension and b) RAABS administration until surgery. Measurements and main results: post-operative acute renal failure was assumed by RIFLE criteria: whether as an increase of 0.5 mg/ dl and/or decrease of creatinine clearance of 75% and/or triplicated the serum creatinine value 48 hours after surgery. 118 patients were included, 83 male. Overall incidence of end point was 13.3%. The incidence was 6.8 vs. 14.3% p=0.38 (0.524 IC 95% 0.15 to 1.83) between discontinuation and continuation respectively.

Conclusion: Discontinuation of RAABS system before coronary surgery did not reduce the incidence of post-operative acute renal failure.