Effects of pneumoperitoneum on kidney injury biomarkers: A randomized clinical trial

Marcos Antonio Marton Filho, Rodrigo Leal Alves, Paulo do Nascimento Junior, Gabriel Dos Santos Tarquinio, Paulo Ferreira Mega, Norma Sueli Pinheiro Módolo, Marcos Antonio Marton Filho, Rodrigo Leal Alves, Paulo do Nascimento Junior, Gabriel Dos Santos Tarquinio, Paulo Ferreira Mega, Norma Sueli Pinheiro Módolo

Abstract

Background: Increased intra-abdominal pressure causes hemodynamic changes that may affect renal biomarkers.

Methods: This randomized, single-blind, single-center clinical trial recruited patients undergoing laparoscopic cholecystectomy at a tertiary care center in Brazil. They were randomly allocated to a standard intra-abdominal pressure group (P10-12, 10-12 mm Hg) and a low intra-abdominal pressure group (P6-8, 6-8 mm Hg). The primary outcome was the change in neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C levels measured at the beginning of the procedure (T0), at the end of the procedure (T1), and 24 hours after the procedure (T2). P-values < 0.05 were considered statistically significant.

Results: In total, 64 patients completed the study-33 were given standard pressure and 31 were given low pressure. There was no significant difference in the biomarker between the groups (P = 0.580), but there was a significant difference between the time points with elevation at T1 (P < 0.001). Similar to NGAL, cystatin C had an elevation at T1 in both groups (P = 0.021), but no difference was found when comparing the groups.

Conclusions: In laparoscopic cholecystectomy, pneumoperitoneum increases NGAL and cystatin C levels intraoperatively, and the use of low-pressure pneumoperitoneum does not change the course of these biomarkers.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Study flowchart.
Fig 1. Study flowchart.
Population selection, randomization and analysis.

References

    1. Srivastava A, Niranjan A. Secrets of safe laparoscopic surgery: Anaesthetic and surgical considerations. J Minim Access Surg 2010;6:91–4. 10.4103/0972-9941.72593
    1. Wagener G, Jan M, Kim M, Mori K, Barasch JM, Sladen RN, et al. Association between increases in urinary neutrophil gelatinase-associated lipocalin and acute renal dysfunction after adult cardiac surgery. Anesthesiology 2006;105:485–91. 10.1097/00000542-200609000-00011
    1. Reyes LF, Severiche-Bueno DF, Bustamante CA, Murillo S, Soni NJ, Poveda M, et al. Serum levels of neutrophil Gelatinase associated Lipocalin (NGAL) predicts hemodialysis after coronary angiography in high risk patients with acute coronary syndrome. BMC Nephrol 2020;21:143 10.1186/s12882-020-01799-5
    1. Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials. BMJ 2010;340:c332 10.1136/bmj.c332
    1. Tecson KM, Erhardtsen E, Eriksen PM, Gaber AO, Germain M, Golestaneh L, et al. Optimal cut points of plasma and urine neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury among critically ill adults: retrospective determination and clinical validation of a prospective multicentre study. BMJ Open 2017;7:e016028 10.1136/bmjopen-2017-016028
    1. Mulier JP, Dillemans B. Anaesthetic Factors Affecting Outcome After Bariatric Surgery, a Retrospective Levelled Regression Analysis. Obes Surg 2019;29:1841–50. 10.1007/s11695-019-03763-1
    1. Gurusamy KS, Vaughan J, Davidson BR. Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. Cochrane Database Syst Rev 2014;CD006930 10.1002/14651858.CD006930.pub3
    1. Aditianingsih D, Mochtar CA, Lydia A, Siregar NC, Margyaningsih NI, Madjid AS, et al. Effects of low versus standard pressure pneumoperitoneum on renal syndecan-1 shedding and VEGF receptor-2 expression in living-donor nephrectomy: a randomized controlled study. BMC Anesthesiol 2020;20:37 10.1186/s12871-020-0956-7
    1. Wever KE, Bruintjes MH, Warlé MC, Hooijmans CR. Renal perfusion and function during pneumoperitoneum: a systematic review and meta-analysis of animal studies. PLoS One 2016;11:e0163419 10.1371/journal.pone.0163419
    1. Srisawat N, Kongwibulwut M, Laoveeravat P, Lumplertgul N, Chatkaew P, Saeyub P, et al. The role of intraoperative parameters on predicting laparoscopic abdominal surgery associated acute kidney injury. BMC Nephrol 2018;19:289 10.1186/s12882-018-1081-4
    1. Brienza N, Giglio MT, Marucci M, Fiore T. Does perioperative hemodynamic optimization protect renal function in surgical patients? A meta-analytic study. Critical care medicine 2009;37:2079–90. 10.1097/CCM.0b013e3181a00a43
    1. Kiseli M, Caglar GS, Yilmaz H, Gursoy AY, Candar T, Pabuccu EG, et al. Neutrophil gelatinase-associated lipocalin levels during pneumoperitoneum. JSLS 2017;21:e2016.00091 10.4293/JSLS.2016.00091
    1. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204-R212.
    1. 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. Crit Care 2007;11:R31 10.1186/cc5713
    1. Section 2: AKI Definition. Kidney Int Suppl (2011) 2012;2:19–36.
    1. Bakal Ü, Sarac M, Tartar T, Kaman D, Kazez A. A study of the utility of novel non-invasive urinary and serum biomarkers of blunt kidney injury in a rat model: NGAL, KIM-1, and IL-18. Cent Eur J Immunol 2019;44:219–225. 10.5114/ceji.2019.89592
    1. Wu B, Chen J, Yang Y. Biomarkers of acute kidney injury after cardiac surgery: a narrative review. Biomed Res Int 2019;2019:7298635 10.1155/2019/7298635
    1. Wei B, Tian T, Liu YG. IL-10 Combined with NGAL Has diagnostic value for AECOPD combined with AKI. Int J Chron Obstruct Pulmon Dis 2020;15:637–44. 10.2147/COPD.S245541
    1. Herget-Rosenthal S, Marggraf G, Hüsing J, Göring F, Pietruck F, Janssen O, et al. Early detection of acute renal failure by serum cystatin C. Kidney Int 2004;66:1115–22. 10.1111/j.1523-1755.2004.00861.x
    1. Royakkers AA, Korevaar JC, Van Suijlen JD, Hofstra LS, Kuiper MA, Spronk PE, et al. Serum and urine cystatin C are poor biomarkers for acute kidney injury and renal replacement therapy. Intensive Care Med 2011;37:493–501. 10.1007/s00134-010-2087-y
    1. Mooney JF, Croal BL, Cassidy S, Lee VW, Chow CK, Cuthbertson BH, et al. Relative value of cystatin C and creatinine-based estimates of glomerular filtration rate in predicting long-term mortality after cardiac surgery: a cohort study. BMJ Open 2019;9:e029379 10.1136/bmjopen-2019-029379
    1. Li F, Hu L, Zhao X, Ge W, Pan H, Zhang W, et al. The value of cystatin C and urinary and serum neutrophil gelatinase-associated lipocalin during the perioperative period of renal transplantation. Transl Androl Urol 2019;8:432–41. 10.21037/tau.2019.08.12
    1. Yong Z, Pei X, Zhu B, Yuan H, Zhao W. Predictive value of serum cystatin C for acute kidney injury in adults: a meta-analysis of prospective cohort trials. Sci Rep 2017;7:41012 10.1038/srep41012
    1. Mishra J, Ma Q, Prada A, Mitsnefes M, Zahedi K, Yang J, et al. Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol 2003;14:2534–43. 10.1097/01.asn.0000088027.54400.c6
    1. Mahmoodpoor A, Hamishehkar H, Fattahi V, Sanaie S, Arora P, Nader ND. Urinary versus plasma neutrophil gelatinase-associated lipocalin (NGAL) as a predictor of mortality for acute kidney injury in intensive care unit patients. J Clin Anesth 2018;44:12–17. 10.1016/j.jclinane.2017.10.010
    1. Lima RM, Navarro LH, Nakamura G, Solanki DR, Castiglia YMM, Vianna PTG, et al. Serum cystatin C is a sensitive early marker for changes in the glomerular filtration rate in patients undergoing laparoscopic surgery. Clinics (Sao Paulo) 2014;69:378–83. 10.6061/clinics/2014(06)02
    1. Fernandes A, Ettinger J, Amaral F, Ramalho MJ, Alves R, Módolo NSP. General anesthesia type does not influence serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in video laparoscopic bariatric surgery. Clinics (Sao Paulo) 2014;69:655–9.
    1. Sodha S, Nazarian S, Adshead JM, Vasdev N, Mohan-S G. Effect of pneumoperitoneum on renal function and physiology in patients undergoing robotic renal surgery. Curr Urol 2016;9:1–4. 10.1159/000442842

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