Effect of uric acid lowering therapy on the prevention of acute kidney injury in cardiovascular surgery
International Urology and Nephrology, 06/04/2012
Ejaz AA et al. – In this study, rasburicase showed no benefit on postoperative serum creatinine in hyperuricemic subjects undergoing cardiac surgery. However, the observation that markers of structural renal injury such as urine neutrophil–associated lipocalin tended to be lower in rasburicase–treated subjects suggests potential different effects of uricase treatment on hemodynamic alterations in renal function versus structural mechanisms of kidney injury.Methods
- In this prospective, double-blind, placebo-controlled, randomized pilot trial, 26 hyperuricemic patients undergoing cardiac surgery were randomized to receive rasburicase or placebo in the preoperative period.
- Subjects receiving rasburicase showed no difference in serum creatinine compared with the control group receiving placebo.
- Despite no difference in primary endpoint, the rasburicase group had less evidence of renal structural injury as reflected by urine neutrophil-associated lipocalin (uNGAL) concentrations, especially in subjects with higher SUA levels, more severe renal dysfunction (baseline GFR ≤45 mL/min/1.73 m2) or heart failure (left ventricular ejection fraction ≤45 %).