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Acetaminophen may help prevent kidney injury after pediatric bypass
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Acetaminophen inhibits the formation of lipid peroxidation molecules that have been linked to acute kidney injury after pediatric cardiopulmonary bypass surgery, according to new data.
Hemolysis during pediatric cardiopulmonary bypass has been associated with lipid peroxidation and acute kidney injury, according to previous research. In an animal model of rhabdomyolysis-induced kidney injury, acetaminophen has been found to reduce both lipid peroxidation levels and the incidence of kidney injury, Hayden J. Zaccagni, MD, of the University of Alabama at Birmingham, said. Zaccagni and colleagues hypothesized that acetaminophen would attenuate lipid peroxidation in children undergoing cardiopulmonary bypass.
“This research is born out of the understanding that bypass often leads to hemolysis, and hemolysis leads to acute kidney injury,” Zaccagni said. “One model of hemolysis-induced kidney injury is … where the buildup of lipid peroxidation molecules, specifically isoprostane and isofuran, lead to vasoconstriction and are potent oxidants as well.”
Hayden J. Zaccagni
The researchers randomly assigned 30 children who were undergoing cardiopulmonary bypass surgery at Vanderbilt University Medical Center to acetaminophen or placebo every 6 hours for four doses starting before surgery. They measured markers of hemolysis, lipid peroxidation and acute kidney injury during the perioperative period.
The findings were presented at Cardiology 2014: The 17th Annual Update on Pediatric and Congenital Cardiovascular Disease.
Cardiopulmonary bypass was associated with increases in free hemoglobin (pre-bypass, 9.8 mg/dL; post-bypass peak, 201.5 mg/dL) and plasma and urine isofuran and F2-isoprostane concentrations. The increase in isofuran was greater than the increase in isoprostane, the researchers reported.
Compared with the placebo group, the acetaminophen group had a lower increase in plasma isofurans (P=.02). However, there was no statistical difference between the groups in plasma F2-isoprostanes or urinary markers of lipid peroxidation. There were also no statistical differences between the groups in postoperative creatinine, urinary neutrophil gelatinase-associated lipocalin or prevalence of acute kidney injury, though the study was not statistically powered to demonstrate those effects, according to Zaccagni.
“What we were able to show is that acetaminophen can inhibit the formation of lipid peroxidation molecules, specifically isofuran, and thus have a potential role in preventing acute kidney injury after bypass in our patients,” Zaccagni said.
Future studies are needed to determine whether more efficient inhibition of lipid peroxidation could reduce acute kidney injury, according to the researchers.
For more information:
Zaccagni HJ. Abstract #706. Presented at: Cardiology 2014, the 17th Annual Update on Pediatric and Congenital Cardiovascular Disease; Feb. 19-23, 2014; Lake Buena Vista, Fla.
Disclosure: Zaccagni reports no relevant financial disclosures.