Inhaled Nitric Oxide Could Reduce Kidney Problems After Heart Surgery
In This Article
- Administering nitric oxide to heart surgery patients during or after surgery may be protective against future kidney disorders
- Heart surgery, such as a valve replacement that requires prolonged cardiopulmonary bypass, disrupts circulating blood cells and the release of hemoglobin, which can lead to acute kidney injury and kidney failure
- Nitric oxide, a gas normally produced by cells in the lining of blood vessels, could act to render hemoglobin inactive, thus decreasing the risk of kidney injury
- In this study, 64% of patients in the control group developed acute kidney injury following surgery, compared to only 50% of patients who received nitric oxide
- Nitric acid is the first drug that has been shown to reduce rates of kidney injury after prolonged cardiopulmonary bypass
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Heart surgery, such as a valve replacement that requires prolonged cardiopulmonary bypass, disrupts circulating red blood cells and the release of hemoglobin, which can lead to acute kidney injury and kidney failure. A recent randomized trial published in the American Journal of Respiratory and Critical Care Medicine found that patients who are administered nitric oxide gas during heart surgery or for the next 24 hours after may have a reduced chance of developing acute or chronic kidney disorders.
The team, led by Lorenzo Berra, MD, medical director of respiratory care at Massachusetts General Hospital, sought to test whether nitric oxide, a gas normally produced by cells in the lining of blood vessels, might render hemoglobin inactive and thus decrease the risk of acute and chronic kidney injury.
The trial followed 244 Chinese adults undergoing cardiopulmonary bypass for at least 90 minutes. The 117 participants randomized to the treatment group received 80 parts per million of nitric oxide during the procedure and for 24 hours afterward, while the 127 participants in the control group received nitrogen gas.
Results showed that 64% of patients in the control group developed acute kidney injury following surgery, compared to only 50% of patients who received nitric oxide. Researches also reported lower rates of stage 3 chronic kidney disease among the treatment group a year after surgery—with 31% of placebo group participants experiencing the disease, compared to 18% of patients in the treatment group.
Dr. Berra and his colleagues point out that while this method could prove beneficial in part for its lack of harmful effects on patients, nitric oxide may affect individual patients in different ways. Future research is necessary to determine whether nitric oxide may have similar effects on people of different demographics, and undergoing different types of surgery.
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