Koroner Arter Bypass Cerrahisi Uygulanan Diabetik Hastalarda Nebivolol ve Metoprololün Böbrek Koruyucu Etkilerinin Karşılaştırılması

Giriş: Çalışmanın amacı koroner arter baypas cerrahisi uygulanan hastalarda nebivololün postoperatif böbrek hasarına karşı metoprolole göre daha iyi koruma sağlayıp sağlamadığını belirlemektir. Hastalar ve Yöntem: Altmış diyabetik hasta nebivolol (Grup I, n= 30) veya metoprolol (Grup II, n= 30) kullanımına göre iki gruba ayrıldı. Grup I’deki hastalar 5 mg/gün nebivolol, Grup II’deki hastalar ise 50 mg/ gün metoprolol kullanan hastalardan seçildi. Postoperatif böbrek fonksiyonları serum nötrofil jelatinaz ile ilişkili lipokalin (NGAL) ve serum kreatinin düzeylerinin seri ölçümleriyle değerlendirildi. p< 0.05 değeri istatistiksel anlamlı kabul edildi. Bulgular: İki grup arasında demografik, preoperatif klinik parametreler ve operatif değişkenler benzerdi. Postoperatif iki saatlik NGAL pozitifliği olan hasta sayısı iki grup arasında fark saptanmadı (7 [% 26.9] ve 7 [% 25.9] p= 0.93). Her gruptan sadece 1 hastada 24. saatte referans sınırdan daha yüksek kreatinin değerleri varken, her gruptan 7 hastada 72 saatlik kreatinin pozitifliği gözlendi. Tüm hastalar renal replasman tedavisi ile düzeldi ve hemodiyaliz gereksinimi olmadı. Sonuç: Koroner arter baypas cerrahisi uygulanan diyabetik hastalarda nebivolol ile metoprolol kullanımı arasında erken böbrek hasarına karşı koruyucu etki açısından fark saptanmadı.

Renal Protective Effect of Nebivolol vs. Metoprolol in Diabetic Patients Undergoing Coronary Artery Bypass Surgery

Introduction: This study aimed to determine whether pre-treatment with nebivolol provides better protection against postoperative renal injury than metoprolol in patients undergoing coronary artery bypass grafting. Patients and Methods: Sixty diabetic patients were divided into two groups as those receiving either nebivo lol (Group I, n= 30) or metoprolol (Group II, n= 30) treatment. The patients in Group I were initiated on ne bivolol 5 mg/day and those in Group II were initiated on metoprolol 50 mg/day. Postoperative renal functions were assessed by serial measurements of serum neutrophil gelatinase associated lipocalin (NGAL) and serum creatinine levels. P< 0.05 was considered as the level of statistical significance. Results: Demographic, preoperative clinical parameters and operative variables were similar between the two groups. The number of patients with two-hour NGAL positivity was not different between the two groups (7 [26.9%] vs. 7 [25.9%] p= 0.93). Only 1 patient from each group had higher creatinine values than the refer ence limit at 24 hours; whereas, 72-hour creatinine positivity was observed in 7 patients from each group. All patients achieved improvement with renal replacement therapy and hemodialysis requirement did not occur. Conclusion: Any difference between the use of metoprolol and nebivolol was not found in terms of better protection against early renal impairment in diabetic patients who underwent coronary artery bypass grafting.

PDF

___

1. Brown JR, Cochran RP, MacKenzie TA, Furnary AP, Kunzelman KS, Ross CS, et al. Long-term survival after cardiac surgery is predicted by estimated glomerular filtration rate. Ann Thorac Surg 2008;86:4-11.
2. Nickolas TL, O’Rourke MJ, Yang J, Sise ME, Canetta PA, Barasch N, et al. Sensitivity and specificity of a single emergency department measure ment of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury. Ann Intern Med 2008;148:810-9.
3. Chertow GM, Levy EM, Hammermeister KE, Grover FE, Daley J. Inde pendent association between acute renal failure and mortality following cardiac surgery. Am J Med 1998;104:343-8.
4. Mehta RH, Grab JD, O’Brien SM, Bridges CR, Gammie JS, Haan CK, et al. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation 2006;114:2208-16.
5. Michael P. Nebivolol: Pharmacologic profile of an ultraselective, vasodi latory β1-blocker. J Clin Pharmacol 2008;48:225-39.
6. Pires MJ, Rodríguez-Peña AB, Arévalo M, Cenador B, Evangelista S, Es teller A, et al. Long-term nebivolol administration reduces renal fibrosis and prevents endothelial dysfunction in rats with hypertension induced by renal mass reduction. J Hypertens 2005;25:2486-96.
7. Groot AA, Mathy MJ, Zwieten PA, Peters SL. Antioxidant activity of ne bivolol in the rat aorta. J Cardiovasc Pharmacol 2004;43:148-53.
8. Toprak O, Cirit M, Tanrısev M, Yazıcı C, Canoz O, Sipahioglu M, et al. Preventive effect of nebivolol on contrast-induced nephropathy in rats. Nephrol Dial Transplant 2008;23:853-9.
9. Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, et al. Neu trophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005;365:1231-8.
10. Wagener G, Gubitosa G, Wang S, Borregaard N, Kim M, Lee HT. Urinary neutrophil gelatinase-associated lipocalin and acute kidney injury after cardiac surgery. Am J Kidney Dis 2008;52:425-33.
11. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Critical Care 2007;11:R31.
12. Brown JR, Cochran RP, MacKenzie TA, Furnary AP, Kunzelman KS, Ross CS, et al. Long-term survival after cardiac surgery is predicted by estimated glomerular filtration rate. Ann Thorac Surg 2008;86:4-11.
13. Bove T, Calabro MG, Landoni G, Aletti G, Marino G, Crescenzi G, et al. The incidence and risk of acute renal failure after cardiac surgery. J Cardiothorac Vasc Anesth 2004;18:442-5.
14. Karkouti K, Beattie WS, Wijeysundera DN, Rao V, Chan C, Dattilo KM, et al. Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg 2005;129:391-400.
15. Drey N, Roderick P, Mullee M, Rogerson M. A population-based study of the incidence and outcomes of diagnosed chronic kidney disease. Am J Kidney Dis 2003;42:677-84.
16. Flaherty JD, Davidson CJ. Diabetes and coronary revascularization. JAMA 2005;293:1501-8.
17. Alserius T, Hammar N, Nordqvist T, Ivert T. Improved survival after coronary artery bypass grafting has not influenced the mortality disad vantage in patients with diabetes mellitus. J Thorac Cardiovasc Surg 200;138:1115-22.
18. Hueb W, Gersh BJ, Costa F, Lopes N, Soares PR, Dutra P, et al. Impact of diabetes on five-year outcomes of patients with multivessel coronary artery disease. Ann Thorac Surg 2007;83:93-9.
19. Rajakaruna C, Rogers CA, Suranimala C, Angelini GD, Ascione R. The effect of diabetes mellitus on patients undergoing coronary surgery: A risk-adjusted analysis. J Thorac Cardiovasc Surg 2006;132:802-10.
20. Calafiore AM, Di Mauro M, Di Giammarco G, Contin Mi, Vitolla G, Ca nosa C, et al. Effect of diabetes on early and late survival after isolated first coronary bypass surgery in multivessel disease. J Thorac Cardiovasc Surg 2003;125:144-54.
21. Kubal C, Srinivasan AK, Grayson AD, Fabri BM, Chalmers JAC. Effect of risk-adjusted diabetes on mortality and morbidity after coronary artery bypass surgery. Ann Thorac Surg 2005;79:1570-6.
22. Haase-Fielitz A, Bellomo R, Devarajan P, Story D, Matalanis G, Dragun D, et al. Novel at conventional biomarkers predicting acute kidney injury following cardiothoracic surgery - a prospective cohort study. Crit Care Med 2009;37:553-60.
23. Mishra J, Ma Q, Prada A, Mitsnefes M, Zahedi K, Yang J, et al. Identifica tion of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol 2003;14:2534-43.
24. Koyner JL, Garg AX, Coca SG. Biomarkers predict progression of acute kidney injury after cardiac surgery. J Am Soc Nephrol 2012:23:905-14.
25. Wyckoff T, Augoustides JG. Advances in acute kidney injury associated with cardiac surgery: the unfolding revolution in early detection. J Cardio thorac Vasc Anesth 2012;2:340-5.
26. Prabhu A, Sujatha DI, Ninan B, Vijayalakshmi MA. Neutrophil gelatinase associated lipocalin as a biomarker for acute kidney injury in patients un dergoing coronary artery bypass grafting with cardiopulmonary bypass. Ann Vasc Surg 2010;24:525-31.
27. Maffei A, Lembo G. Nitric oxide mechanisms of nebivolol. Ther Adv Car diovasc Dis 2009;3:317-27.
28. Raij L. Nitric oxide and cardiovascular and renal effects. Osteoarthritis and Cartilage 2008;16:21-6.
29. Christopher SW. Reactive oxygen species: Roles in blood pressure and kidney function. Current Hypertension Reports 2002;4:160-6.
30. Greven J, Gabriels G. Effect of nebivolol, a novel beta 1-selective adreno ceptor antagonist with vasodilating properties, on kidney function. Arz neimittelforschung 2000;50:973-9.
31. Wolf SC, Sauter G, Preyer M. Influence of nebivolol and metoprolol on inflammatory mediators in human coronary endothelial or smooth muscle cells. Effects on neointima formation after balloon denudation in carotid arteries of rats treated with nebivolol. Cell Physiol Biochem 2007;19:129- 36.
32. Nosadini R, Tonolo G. Relationship between blood glucose control, pathogenesis, and progression of diabetic nephropathy. J Am Soc Nephrol 2004;15:1-5.
33. Jafar TH, Schmid CH, Laveda M, Giatras I, Toto R, Remuzzi G, et all. Angiotensin converting enzyme inhibitors and the progression of non diabetic renal disease: a meta-analysis of patient level data. Ann Intern Med 2001;135:73-87.
34. Lindeman RD. Hypertension and kidney protection in the elderly: what is the evidence in 2007? Int Urol Nephrol 2007;39:669-78.
35. Ito H, Nagatomo Y, Kohno T, Anzai T, Meguro T, Ogawa S, et al. Dif ferential effects of carvedilol and metoprolol on renal function in patients with heart failure. Circ J 2010;74:1578-83.
36. Kalinowski L, Dobrucki LW, Szczepanska-Konkel M, Jankowski M, Martyniec L, Angielski S, et all. Third-generation β-blockers stimulate nitric oxide release from endothelial cells through ATP efflux: A novel mechanism for antihypertensive action. Circulation 2003;107;2747-52.
37. Prowle JR, Calzavacca P, Licari E. Pilot double-blind, randomized con trolled trial of short-term atorvastatin for prevention of acute kidney in jury after cardiac surgery. Nephrology (Carlton) 2012;17:215-24.

ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi