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Kidney Week

Abstract: PO2619

High Serum Strontium May Predict AKI After Cardiac Surgery with Cardiopulmonary Bypass

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Tomita, Natsumi, Department of Hospital Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
  • Hotta, Yuji, Department of Hospital Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
  • Matsuta, Karin, Department of Hospital Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
  • Ito, Hidekazu, Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
  • Yamamoto, Yuko, Aichi-ken Eisei Kenkyujo, Nagoya, Aichi, Japan
  • Ohashi, Kazuki, Department of Pharmacy, Nagoya City University Hospital, Nagoya, Japan
  • Kondo, Masahiro, Department of Pharmacy, Nagoya City University Hospital, Nagoya, Japan
  • Hayakawa, Tomoaki, Department of Pharmacy, Nagoya City University Hospital, Nagoya, Japan
  • Kataoka, Tomoya, Department of Hospital Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
  • Sobue, Kazuya, Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
  • Kimura, Kazunori, Department of Hospital Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, Japan
Background

The prevalence of acute kidney injury after cardiac surgery under cardiopulmonary bypass (AKI-CPB) is high and it worsens patient prognosis, which renders it a major concern during intensive care. Therefore, a predictable marker of AKI-CPB is required. Because some trace metals have been found to affect renal injury, we investigated their association with AKI-CPB.

Methods

Study 1. We enrolled 30 patients from the Nagoya City University Hospital. Serum concentrations of 19 trace metals were measured before surgery and immediately after CPB withdrawal. We defined AKI according to the KDIGO criteria. Factors associated with AKI-CPB were identified by univariate and multivariate analyses. Study 2. We treated male Wistar-ST rats with 1 mg/kg/day of strontium (Sr) or vehicle orally for 3 days, followed by the application of 30 min of ischemia and reperfusion to cause renal injury. Serum creatinine (SCr) and blood urea nitrogen (BUN) levels were evaluated 24 h later. We also incubated human kidney (HK)-2 cells with Sr (0.25 µM, high-Sr or 0.19 µM, normal-Sr) or PBS for 24 h in vitro. These Sr concentrations were determined according to the average serum Sr concentrations in patients with and without AKI. The cells were incubated under normoxia (20% O2) or hypoxia (1% O2) conditions; then, cell viability and mRNA expression were assessed.

Results

Study 1. The incidence of AKI-CPB was 30% (n = 9). Serum Cr levels before surgery were high in the AKI group. Intraoperative factors did not differ between patients with and without AKI. Univariate analysis revealed significantly higher levels of Sr and arsenic before surgery, and higher Sr, arsenic, and zinc levels after CPB in the AKI group (p < 0.05). Multivariate analysis showed that only Sr levels after CPB withdrawal correlated independently with AKI. Study 2. The SCr and BUN levels were higher in Sr treated rats than vehicle treated rats. Incubating HK-2 cells with Sr did not affect their viability under normoxia and hypoxia conditions. However, NF-κB mRNA levels increased only under hypoxia conditions following exposure to high Sr levals.

Conclusion

High Sr levels before CPB may be a useful predictor of AKI-CPB. This study suggested that high Sr levels enhance ischemia-induced inflammation following CPB.