Abstract
Abstract 340: Greater Intraoperative HDL Particle Loss is Associated With Less Acute Kidney Injury After Cardiac Surgery
Arteriosclerosis, thrombosis, and vascular biology, Vol.39(Suppl_1)
05/2019
DOI: 10.1161/atvb.39.suppl_1.340
Abstract
Abstract only Introduction: Twenty-five percent of cardiac surgery patients develop postoperative acute kidney injury (AKI). A higher preoperative HDL cholesterol concentration is associated with a lower risk of AKI after cardiac surgery. HDL’s paraoxonase-1 (PON-1) enzyme can decrease oxidative stress and may attenuate AKI. We measured HDL particle concentration and PON-1 activity to test the hypothesis that perioperative HDL particle changes are associated with oxidative stress and AKI. Methods: After IRB approval, we analyzed plasma from 75 patients who did and 75 patients who did not develop AKI, matched on baseline kidney function, Thakar AKI risk score, and cardiopulmonary bypass time, from a prospective trial of atorvastatin to prevent postoperative AKI. HDL particle concentration was measured using the NMR Lipoprofile test. PON-1 activity was measured with the fluorescent substrate 7-diethylphospho-6,8-dixuor-4-methylumbelliferyl. Serum amyloid A (SAA) was measured with an ELISA. Logistic and linear regression modeling, adjusted for AKI risk factors, were used to assess the relationships between HDL particle changes and outcomes. Results: On average, patients lost HDL particles intraoperatively, even after adjustment for volume of intraoperative fluids administered (p<0.001). Intraoperative loss of plasma HDL particles was accompanied by HDL-associated PON-1 activity loss (R=0.37, p<0.001), but was not associated with plasma SAA gain (R= -0.10, p=0.39). Greater intraoperative HDL particle loss was associated with a lower odds of developing AKI (OR 0.79, 95% CI (0.67-0.93), p<0.01). Further, each 1 μmol/L decrease in intraoperative HDL plasma particles was associated with a 3.4 pg/mL decrease in postoperative plasma isofurans, an in vivo marker of oxidative stress (p=0.04). Conclusion: Intraoperative loss of HDL particles from the circulation is associated with decreased plasma PON-1 activity and decreased in vivo oxidative stress and AKI. The mechanism of intraoperative HDL particle loss from the circulation remains unclear. Future studies will investigate whether HDL particles attenuate AKI by reducing oxidative stress in the subendothelial space.
Details
- Title: Subtitle
- Abstract 340: Greater Intraoperative HDL Particle Loss is Associated With Less Acute Kidney Injury After Cardiac Surgery
- Creators
- Loren E Smith - Vanderbilt UniversityDerek K Smith - Vanderbilt UniversityPatricia G Yancey - Vanderbilt UniversityAlan T Remaley - National Institutes of HealthFrederic T Billings - Vanderbilt UniversityMacrae F Linton - Vanderbilt University
- Resource Type
- Abstract
- Publication Details
- Arteriosclerosis, thrombosis, and vascular biology, Vol.39(Suppl_1)
- DOI
- 10.1161/atvb.39.suppl_1.340
- ISSN
- 1079-5642
- eISSN
- 1524-4636
- Language
- English
- Date published
- 05/2019
- Academic Unit
- Anesthesia
- Record Identifier
- 9984958639102771
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