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Diltiazem may preserve renal tubular integrity after cardiac surgery

[Le diltiazem peut préserver l’intégrité tubulaire rénale à la suite d’une intervention cardiaque]

Swen N. Piper, MD^*, Bernhard Kumle, MD^*, Wolfgang H. Maleck, MD^*, Arndt-Holger Kiessling, MD, Andreas Lehmann, MD^*, Kerstin D. Röhm, MD^*, Stefan W. Suttner, MD^* and Joachim Boldt, MD^*

^* From the Departments of Anesthesiology and Critical Care Medicine; Thoracic and
Cardiac Surgery, Klinikum Ludwigshafen, Ludwigshafen, Germany.

Address correspondence to: Dr. Swen N. Piper, Department of Anesthesiology and Critical Care Medicine, Klinikum Ludwigshafen, Bremserstraße 79, D-67063 Ludwigshafen, Germany. Phone: 0049 621-503-3000; Fax: 0049-621-503-3024; E-mail: swen.n.piper{at}t-online.de

Purpose: To evaluate the influence of dopamine and diltiazem on renal function and markers for acute renal failure, including urinary alpha-glutathion s-transferase (-GST), alpha-1-microglobulin (₁-MG) and N-acetyl-ß-glucosaminidase (ß-NAG) after extracorporeal circulation.

Methods: In a randomized, placebo-controlled, double-blind trial we evaluated the efficacy of dopamine (2.5 µg•kg^-1•min^-1), diltiazem (2 µg•kg^-1•min^-1) or placebo administered over 48 hr postoperatively to maintain renal tubular integrity in 60 elective cardiac surgery patients. -GST, ₁-MG, ß-NAG, and creatinine clearance were measured from urine collected during surgery (T0), the first four hours (T1), 24 hr (T2) and 48 hr (T3) postoperatively.

Results: Cumulative urine output in the diltiazem group (9.0 ± 2.8 L) increased significantly compared with placebo (7.0 ± 1.6 L), but not compared with dopamine (7.8 ± 1.8 L). Creatinine clearance showed no significant intergroup differences. In all groups ₁-MG increased from T0 to T3, but we found no significant intergroup differences. -GST increased significantly from T0 to T3 in the placebo (2.1 ± 1.8 to 11.4 ± 8.6 µg•L^-1) and in the dopamine groups (2.7 ± 1.8 to 13.6 ± 14.9 µg•L^-1), but not in the diltiazem group (1.8 ± 1.4 to 3.2 ± 3.2 µg•L^-1). Forty-eight hours postoperatively -GST was significantly lower in the diltiazem group than in both other groups.

Conclusions: Diltiazem stimulates urine output, reduces excretion of -GST and ß-NAG and may be useful to maintain tubular integrity after cardiac surgery.

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