'Asthma drug before cardiac surgery prevents renal failure'

'Asthma drug before cardiac surgery prevents renal failure'
Preetu Nair, TNN

PANAJI: Aminophylline, a drug used to treat wheezing and other breathing difficulties such as asthma, if given to patients undergoing cardiac
surgery is an effective strategy to prevent post operative renal failure.

The effectiveness of aminophylline for prevention of renal impairment after cardiac surgery was evaluated on 138 patients undergoing cardiac surgery and it was found that patients who received preoperative aminophylline infusion had lower incidence of acute kidney injury (AKI) after cardiac surgery, than those who didn't receive it.

Explaining that it is important to administer aminophylline before cardiac operation to prevent renal failure, Dr Amol Mahaldar, department of nephrology, Meenakshi mission hospital and research centre, Madurai said, "The incidence of acute kidney injury (AKI) after cardiac surgery remains high, despite improvements in surgical techniques and preoperative care, and is associated with an unacceptably high mortality. Aminophylline has shown to confer benefit in experimental and clinical acute renal failure (ARF) due to ischemia, contrast media and various nephrotoxic agents."

Sixty-three patients received aminophylline of 5 mg and a subsequent continuous infusion of 0.25 mg per hour for up to 72 hours, while 75 patients received usual post operative care (isotonic saline infusion). Serum creatinine concentrations were measured preoperatively and daily until day 5 after surgery, the glomerular filtration rate (GFR), a marker for kidney function and post-operative hourly urine output was recorded.

The results showed that those who received preoperative aminophylline infusion had lower incidence of AKI than those who didn't receive aminophylline infusion but had post operative care.

Dr Mahaldar presented the results of the study, "A Prospective Study of Intravenous Aminophylline for the prevention of Acute Kidney Injury in Cardiac Surgery", at the just concluded silver jubilee conference of Indian Society of Nephrology West zone chapter and it won him the best paper award in the free paper section of the conference.

The paper notes that ARF, depending on the specific definition, occurs in up to 30% of all patients who undergo cardiac surgery. ARF that requires dialysis occurs in approximately 1%. "The development of kidney injury is associated with a high mortality, a more complicated hospital course, and a higher risk for infectious complications. Even minimal changes in serum creatinine that occur in the postoperative period are associated with a substantial decrease in survival," Dr Mahaldar said.

Also majority of patients develop ARF that requires dialysis and remain dialysis dependent, leading to significant long-term morbidity and mortality, he added.

15 September 2009, The Times of India, Goa edition