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Division of Nephrology, Department of Medicine, University of Washington,
Seattle, Washington.
Department of Anesthesiology, University of Washington, Seattle,
Washington.
Division of Cardiothoracic Surgery, Department of Surgery, University of
Washington, Seattle, Washington.
Correspondence to Connie L. Davis, Transplantation Services, Box 356174, 1959 NE Pacific Street, Seattle, WA 98195. Phone: 206-548-6079; Fax: 206-548-6706; E-mail: cdavis{at}u.washington.edu
Abstract
Abstract. Acute renal failure (ARF) requiring dialysis occurs in
up to 4% of patients after cardiopulmonary bypass (CPB). CPB leads to the
generation of intravascular free hemoglobin, resulting in increased
endothelial and renal tubular cell free iron, which is associated with renal
injury. Conversely, renoprotection is conferred by processes that upregulate
heme and iron sequestration pathways, such as ferritin. This study evaluates
the influence of free hemoglobin generation during CPB and the capacity to
sequester free iron on the occurrence of post-CPB renal insufficiency. Thirty
consecutive patients undergoing CPB were enrolled in the study. Serum
creatinine, free hemoglobin, and ferritin were measured preoperatively, at the
end of bypass, and 24 and 48 h after surgery. Renal injury, as determined by
an increase in the serum creatinine of 
25% (ARF) by 48 h after surgery,
occurred in 40% (12 of 30) of patients, and dialysis was necessary in 6.6% (2
of 30). Free hemoglobin levels increased in all patients but did not correlate
with postoperative ARF. However, patients with preoperative serum ferritin
levels 
130 µg/L, the median value for the group, had a sixfold greater
likelihood of developing ARF compared to patients with levels above this value
(P = 0.03). Lower serum ferritin levels appear to be associated with
the development of ARF. Serum ferritin levels may signify intravascular as
well as endothelial and renal epithelial cell ability to bind free iron
generated during CPB-induced hemolysis, and thus may help provide information
regarding the risk for ARF.
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