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Chronic angiotensin converting inhibition does not influence renal hemodynamic and function during cardiac surgery

Canadian Journal of Anesthesia volume 46, pages 626–634 (1999)Cite this article

Abstract

Purpose

Treatment with angiotensin-converting enzyme (ACE) inhibitors affects the autoregulation of renal blood flow and glomerular filtration and provides renal protective effects. The purpose of this case-control study was to investigate the effects of chronic ACE inhibition on perioperative renal hemodynamics and function.

Method

We prospectively studied renal function in two groups of patients, chronically treated or not, with ACE inhibitors (ACEI and control; n = 16, in each group) who underwent elective cardiac surgery under hypothermic cardiopulmonary bypass. Glomerular filtration rate, effective renal plasma flow, osmolar clearance and fractional excretion of sodium and potassium were determined before, during and after CPB. Additional measurements included plasma atrial natriuretic factor (ANF) as well as plasma and urinary cyclic GMP (cGMP), thromboxane B2 (T× B2) and 6-keto-PGF1.

Results

Renal functional and hemodynamic variables did not differ between the two groups, at any period. Cardiopulmonary bypass induced increases in urinary flow, osmolar clearance and fractional excretion of sodium and potassium in both groups. Plasma and urinary ratio of 6-keto-PGF1O T× B2 increased markedly and reflected a prédominent systemic and renal release of vasodilatory prostaglandins. Intraoperatively, ANF was higher in ACEIs than in control patients.

Conclusions

Long term treatment with ACE inhibitors does not influence the perioperative changes in renal hemodynamics and function. During cardiopulmonary bypass, a transient impairment in solute reabsorption is associated with renal release of vasodilatory mediators (nitric oxide and prostacyclin).

Résumé

Objectif

Le traitement avec les inhibiteurs de l’enzyme de conversion de l’angiotensine (ECA) agit sur l’autorégulation du débit sanguin rénal et la filtration glomérulaire et a un effet de protection rénale. Lobjectif de cette étude cas-témoins est d’examiner les effets d’une inhibition de longue durée de l’ECA sur l’hémodynamie et la fonction rénales périopératoires.

Méthode

Nous avons réalisé une étude prospective de la fonction rénale chez les patients de deux groupes, traités ou non à long terme avec des inhibiteurs de l’ECA (IECA et témoin; n = 16 dans chacun), et qui subissent une intervention cardiaque élective avec circulation extracorporelle hypothermique. On a déterminé avant, pendant et après la CEC, la vitesse de filtration glomérulaire, le débit sanguin rénal efficace, la clairance osmolaire et la fraction excrétée du sodium et du potassium. D’autres mesures concernent: le facteur natriurétique auriculaire (FNA) et la guanosine monophosphate cyclique urinaire (GMPc), la thromboxane B2 (T× B2) et la 6-céto-PGF

Résultats

À aucun moment, les variables rénales fonctionnelles et hémodynamiques n’ont présenté de différences intergroupes. La CEC a induit une hausse du débit urinaire, de la clairance osmolaire et de la fraction excrétée du sodium et du potassium dans les deux groupes. Les taux plasmatiques et urinaires de 6-céto-PGF1 par rapport à la Tx B2 ont beaucoup augmenté, reflet d’une libération systémique et rénale de prostaglandines vasodilatatrices. Le FNA peropératoire était plus élevé dans le groupe IECA que dans le groupe témoin.

Conclusion

Un traitement à long terme avec les inhibiteurs de l’ECA n’influence pas les changements périopératoires de l’hémodynamie et de la fonction rénales. Une altération transitoire de la réabsorption osmotique pendant la circulation extracorporelle est associée à la libération rénale de médiateurs vasodilatateurs (l’oxyde nitrique et la prostacycline).

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Author information

Affiliations

  1. Division of Anesthesiological Investigations, Geneve, Switzerland

    Marc Licker, Alexandre Schweizer, Laurent Höhn & Denis R. Morel

  2. Division d’Anesthésiologie, Hôpital Cantonal Universitaire, CH-1211, Geneve 14, Switzerland

    Denis R. Morel

Authors
  1. Marc Licker
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  2. Alexandre Schweizer
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  3. Laurent Höhn
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  4. Denis R. Morel
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Correspondence to Marc Licker.

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Licker, M., Schweizer, A., Höhn, L. et al. Chronic angiotensin converting inhibition does not influence renal hemodynamic and function during cardiac surgery. Can J Anesth 46, 626–634 (1999). https://doi.org/10.1007/BF03013949

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Keywords

  • Fractional Excretion
  • Renal Blood Flow
  • Atrial Natriuretic Factor
  • Renal Hemodynamic
  • Effective Renal Plasma Flow