Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Nephron Clin Pract 2009;111:c229–c235 DOI: 10.1159/000208991 Can Pulsatile Cardiopulmonary Bypass Prevent Perioperative Renal Dysfunction during Myocardial Revascularization in Elderly Patients? Pierangela Presta a Francesco Onorati b Laura Fuiano a Pasquale Mastroroberto b Giuseppe Santarpino b Carmela Tozzo c Michele Andreucci a Attilio Renzulli b Giorgio Fuiano a a Nephrology Unit and b Cardiac Surgery Unit, ‘Magna Graecia’ University, Catanzaro, and c Nephrology Unit, ‘Tor Vergata’ University, Rome, Italy tients. No difference was observed for 24 h urine output and blood urea nitrogen. Conclusions: Pulsatile CPB preserves renal function better than standard CPB even in patients old- er than 65. CPB could be adopted as the procedure of choice in this subgroup of patients. Copyright © 2009 S. Karger AG, Basel Introduction The incidence of acute renal failure (ARF) increases markedly in the elderly [1] because of the impaired adap- tation of the older kidney to acute ischemic injuries [2]. This is favored by renal anatomic and functional changes that physiologically occur during the aging process. In particular, the older kidney, even in healthy subjects, has a reduced ability to vasodilate when maximally stimu- lated and a greater susceptibility to volume depletion [3, 4]. Also the frequent coexistence of pathologies predis- posing to renal damage, such as hypertension, diabetes and atherosclerosis, and nephrotoxic drugs increase the risk of renal damage in the elderly [3, 4] . Therefore, all the measures potentially useful to improve renal perfusion during cardiac surgery should be adopted in the elderly patients. In particular, during open-heart surgery in car- dioplegic arrest the higher susceptibility of the elderly pa- tients to develop acute renal dysfunction is further in- Key Words Kidney and aging  Cardiopulmonary bypass complications  Pulsatile perfusion  Renal dysfunction  Renal hypoperfusion  Hyperlactatemia Abstract Backgrounds/Aims: We recently demonstrated that pulsa- tile cardiopulmonary bypass (CPB) versus standard linear CPB is associated with better perioperative renal function. Since older subjects have a higher risk of acute renal failure, we have extended our study to evaluate the specific impact of pulsatile CPB on the perioperative renal function in elder- ly patients. Methods: We enrolled 50 patients with normal preoperative renal function: they were stratified by age (65– 75 vs. 50–64 years) and randomized to nonpulsatile (group A) or pulsatile CPB (group B). Twenty-seven patients aged 650 years and !65 years were randomized to group A (n = 12) or to group B (n = 15) and 23, aged 665 years and ^75 years, to group A (n = 13) or to group B (n = 10). Glomerular filtrate rate (GFR), daily diuresis, lactatemia and other param- eters were measured during the pre- and perioperative pe- riod. Results: The percent perioperative decrease in GFR was lower in group A than in group B (p ! 0.001), without differ- ences between older and younger patients. By contrast, perioperative plasma lactate levels were higher in group A than in group B (p ! 0.001), both in older and younger pa- Received: July 10, 2008 Accepted: September 19, 2008 Published online: March 14, 2009 Giorgio Fuiano, MD Nephrology Unit, ‘Magna Graecia’ University, Campus Germaneto, Viale Europa IT–88100 Catanzaro (Italy) Tel. +39 3356 821 473 E-Mail gfuiano@libero.it or fuiano@unicz.it © 2009 S. Karger AG, Basel 1660–2110/09/1114–0229$26.00/0 Accessible online at: www.karger.com/nec