TY - JOUR
T1 - Preliminary report on the association of apolipoprotein E polymorphisms, with postoperative peak serum creatinine concentrations in cardiac surgical patients
AU - Chew, Sophia T.H.
AU - Newman, Mark F.
AU - White, William D.
AU - Conlon, Peter J.
AU - Saunders, Ann M.
AU - Strittmatter, Warren J.
AU - Landolfo, Kevin
AU - Grocott, Hilary P.
AU - Stafford-Smith, Mark
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2000
Y1 - 2000
N2 - Background: Renal dysfunction after cardiac surgery occurs in up to 8% of patients and is associated with major increases in morbidity, mortality, and cost. Genetic polymorphisms have been implicated as a factor in the progression of chronic renal disease, but a genetic basis for the development of acute renal impairment has not been investigated. The authors therefore tested the hypothesis that apolipoprotein E alleles are associated with different postoperative changes in serum creatinine after cardiac surgery. Methods: The authors performed a prospective observational study with use of data from 564 coronary bypass surgical patients who were enrolled in an ongoing investigation of apolipoprotein E genotypes and organ dysfunction at a university hospital between 1989-1999. Renal function was assessed among apolipoprotein E genotype groups by comparisons of preoperative (CrPre), peak in-hospital postoperative (CrMax) and perioperative change (DCr) in serum creatinine values. Results: The ε4 allele grouping (E2 = 2/2,2/3,2/4; E3 = 3/3; E4 = 3/4,4/4) was associated with a smaller increase in postoperative serum creatinine (perioperative change: E4, +0.17; E3, +0.26; E4, +0.27 mg/dl) and a lower peak postoperative creatinine than the ε2 and ε3 in univariate and multivariate analysis (peak in-hospital postoperative serum creatinine multivariate P = 0.015 vs. ε3, P = 0.038 vs. ε2). There was no difference in baseline creatinine among allele groups. Conclusions: Inheritance of the apolipoprotein ε4 allele is associated with reduced postoperative increase in serum creatinine after cardiac surgery, compared with the ε3 or ε2 allele. This is the first report of a possible genetic basis for acute renal impairment. These data may contribute to renal risk stratification for cardiac surgery and raise questions regarding apolipoprotein E and the pathophysiology of acute renal injury.
AB - Background: Renal dysfunction after cardiac surgery occurs in up to 8% of patients and is associated with major increases in morbidity, mortality, and cost. Genetic polymorphisms have been implicated as a factor in the progression of chronic renal disease, but a genetic basis for the development of acute renal impairment has not been investigated. The authors therefore tested the hypothesis that apolipoprotein E alleles are associated with different postoperative changes in serum creatinine after cardiac surgery. Methods: The authors performed a prospective observational study with use of data from 564 coronary bypass surgical patients who were enrolled in an ongoing investigation of apolipoprotein E genotypes and organ dysfunction at a university hospital between 1989-1999. Renal function was assessed among apolipoprotein E genotype groups by comparisons of preoperative (CrPre), peak in-hospital postoperative (CrMax) and perioperative change (DCr) in serum creatinine values. Results: The ε4 allele grouping (E2 = 2/2,2/3,2/4; E3 = 3/3; E4 = 3/4,4/4) was associated with a smaller increase in postoperative serum creatinine (perioperative change: E4, +0.17; E3, +0.26; E4, +0.27 mg/dl) and a lower peak postoperative creatinine than the ε2 and ε3 in univariate and multivariate analysis (peak in-hospital postoperative serum creatinine multivariate P = 0.015 vs. ε3, P = 0.038 vs. ε2). There was no difference in baseline creatinine among allele groups. Conclusions: Inheritance of the apolipoprotein ε4 allele is associated with reduced postoperative increase in serum creatinine after cardiac surgery, compared with the ε3 or ε2 allele. This is the first report of a possible genetic basis for acute renal impairment. These data may contribute to renal risk stratification for cardiac surgery and raise questions regarding apolipoprotein E and the pathophysiology of acute renal injury.
KW - Acute renal failure
KW - Heart surgery
KW - Postoperative complications
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U2 - 10.1097/00000542-200008000-00008
DO - 10.1097/00000542-200008000-00008
M3 - Article
C2 - 10910477
AN - SCOPUS:0033862282
SN - 0003-3022
VL - 93
SP - 325
EP - 331
JO - Anesthesiology
JF - Anesthesiology
IS - 2
ER -