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High preoperative plasma endothelin-1 levels are associated with increased acute kidney injury risk after pulmonary endarterectomy

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Abstract

Objectives

The only curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). PEA requires cardiopulmonary bypass (CPB) which is associated with a high acute kidney injury (AKI) risk. Circulating endothelin-1 (ET-1) levels are elevated in CTEPH, and ET-1 plays a pivotal role in AKI. Because AKI is burdened by high morbidity and mortality, we aimed to evaluate the association between preoperative ET-1 and the risk to develop AKI in CTEPH individuals who undergo PEA. We also evaluated the association of AKI and ET-1 with kidney function and mortality at 1 year after PEA.

Methods

In 385 consecutive patients diagnosed with CTEPH who underwent PEA at the Foundation IRCC Policlinico San Matteo (Pavia, Italy) from January 2009 to April 2015, we assessed preoperative circulating ET-1 by ELISA and identified presence of AKI based on 2012 KDIGO criteria.

Results

AKI occurred in 26.5% of the 347 patients included in the analysis, and was independently associated with preoperative ET-1 (p = 0.008), body mass index (BMI) (p = 0.022), male gender (p = 0.005) and duration of CPB (p = 0.002). At 1-year post PEA, estimated glomerular filtration rate (eGFR) significantly improved in patients who did not develop AKI [ΔeGFR 5.6 ml/min/1.73 m2 (95% CI 3.6–7.6), p < 0.001] but not in those with perioperative AKI. AKI (p < 0.001), age (p < 0.001), preoperative eGFR (p < 0.001) and systemic hypertension diagnosis (p = 0.015) were independently associated with 1-year ΔeGFR. Neither perioperative AKI nor preoperative ET-1 was associated with 1-year survival.

Conclusion

Perioperative AKI is associated with higher preoperative circulating ET-1 and it negatively influences long-term kidney function in patients with CTEPH who undergo PEA.

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Acknowledgements

The authors thank Dr. Cristina Torre for outstanding technical support.

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Authors and Affiliations

  1. Unit of Nephrology, Dialysis, Transplantation, Foundation I.R.C.C.S. Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy

    Fabrizio Grosjean, Vincenzo Sepe & Teresa Rampino

  2. Immuno-Allergy Laboratory, Pediatric Clinic, University of Pavia, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy

    Mara De Amici & Giorgia Testa

  3. Service of Clinical Epidemiology and Biometry, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy

    Catherine Klersy

  4. Nephrology and Dialysis, ASST Cremona, Cremona, Italy

    Gianluca Marchi

  5. Unit of Cardiac Surgery, Intrathoracic-Trasplantation and Pulmonary Hypertension, School of Medicine, University of Pavia, Foundation I.R.C.C.S. Policlinico San Matteo, Pavia, Italy

    Antonio Sciortino, Maurizio Pin, Valentina Grazioli, Anna Celentano, Benedetta Vanini & Andrea Maria D’Armini

  6. School of Medicine, University of Pavia, Pavia, Italy

    Federica Spaltini

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  1. Fabrizio Grosjean
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Correspondence to Fabrizio Grosjean.

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Conflict of interest

Andrea Maria D’Armini: Actelion Pharmaceuticals Ltd, Bayer HealthCare, Merk Sharp Dohme. Catherine Klersy, Statistical consultant for Livanova (occasional).

Ethical statement

This retrospective study was approved by our Institutional Ethic Committee (protocol number 20150016628) and all the procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent was not required.

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Grosjean, F., De Amici, M., Klersy, C. et al. High preoperative plasma endothelin-1 levels are associated with increased acute kidney injury risk after pulmonary endarterectomy. J Nephrol 31, 881–888 (2018). https://doi.org/10.1007/s40620-018-0538-7

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