The simplified modification of diet in renal disease equation as a predictor of renal function after coronary artery bypass graft surgery.

BACKGROUND: After open-heart surgery, a percentage of patients have impaired renal function. This deterioration is even seen in patients with serum creatinine (s-creatinine) values that fall within the normal laboratory range, therefore s-creatinine is not an accurate reflection of renal function. Glomerular filtration rate (GFR) is a better indication of renal status. GFR can be calculated with the simplified modification of diet in renal disease (MDRD) equation - a formula that takes age, gender, race and s-creatinine level into account. The purpose of this study was to investigate the relationship between estimated GFR pre-operatively and renal impairment postoperatively. METHODS: All patients who had an isolated coronary artery bypass graft (CABG) done by one surgeon in one hospital between January 2005 and October 2007 had their s-creatinine levels determined pre-operatively. Using a computer desktop calculator, the patient's age, gender and race were used together with the s-creatinine value to estimate the GFR. Prior to CABG, all patients were grouped into the five stages of chronic kidney disease. Renal outcome postoperatively was compared with the estimated pre-operative GFR. RESULTS: Nineteen per cent of the 451 patients had chronic kidney disease pre-operatively, as defined by the National Kidney Foundation, according to their estimated GFR. Twenty-three per cent of these patients had renal impairment after surgery. Of the patients with reasonable renal function pre-operatively only 4% had further deterioration of renal function. Mortality did not differ significantly, but patients with postoperative renal impairment stayed in hospital on average 2.4 days longer than those who had no renal impairment postoperatively. CONCLUSIONS: Patients with chronic kidney disease before CABG have a six times greater chance of developing further renal impairment postoperatively than those with reasonable renal function beforehand. There is therefore a significant relationship between estimated GFR before CABG and deterioration of kidney function after surgery. The GFR, as calculated with the simplified MDRD, is a predictor of the risk of having renal dysfunction after CABG.

[Studies of individual patterns of blood proteins control during simulation of the microgravity effects on humans].

Blood samples taken from test-subjects in the 7-d immersion experiment were analyzed for blood proteins belonging to alpha1- and alpha2-globulins electrophoretic fractions: alphal-antitripsin (alpha1-AT), a1-acidic glycoprotein (alpha1-AGP), ceruplasmin (Cer), haptoglobin (Hp), alpha2-macroglobulin (alpha2-M), apolipoprotein A (ApoA). Immersion was demonstrated to alter concentrations of the studied proteins; besides, it was shown that return to the normal state could also affect protein concentrations. Immersion effects on blood proteins patterned after acute reaction. Temporal profiles of alpha1-AGP, Cer, alpha2-M, Hp and ApoA were identical in all the test-subjects. Differences were mostly in the speed and amplitude of concentrations shifting. However, alpha1-AT showed a diversity of trends, whereas ApoA was common to all the subjects, three of them had this protein dropped below the bottom reference range. In two of these subject, baseline ApoA concentrations were also significantly lower in comparison to the others. These results infer that monitoring of blood alpha1-AT and ApoA in the period of adaptation to a changed environment may provide information useful for assessment of individual adaptability.