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1 From the Department of Cardiothoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan, and the Department of Thoracic Surgery, Tohoku University, Sendai, Japan
Study objective: Acute renal failure, which is a serious complication following open heart surgery, has a high mortality rate. Previous reports have shown that the calcium antagonist diltiazem is beneficial either as an adjunct to cardioplegic solution or perioperative treatment for preservation of postoperative cardiovascular function. We studied the effects of diltiazem on renal function, plasma atrial natriuretic peptide levels, and the renin-angiotensin-aldosterone system in patients who had undergone coronary artery bypass grafting.
Patients and measurements: Diltiazem was administered, 0.1 mg/kg, in a bolus injection followed by continuous infusion at a rate of 2 µ/kg/min during surgery, and 30 mg through a nasogastric tube at every 8 h. Hemodynamics, renal function, and plasma hormone levels were measured in the diltiazem-treated group (n=13) and the nontreated group (n=10).
Results: Heart rate, mean arterial pressure, and systemic vascular resistance index in the diltiazem-treated group were significantly lower than those in the nontreated group following cardiopulmonary bypass. Urine volume, creatinine clearance, and free water clearance were well preserved in the diltiazem-treated group. However, plasma renin activity and aldosterone levels were significantly higher in the diltiazem-treated group with the same changes in plasma atrial natriuretic peptide levels.
Conclusion: Perioperative treatment with diltiazem has a beneficial effect on postoperative renal function, and reflex sympathetic activation induced by peripheral vasodilation activated the renin-angiotensin-aldosterone system.
Key Words: aldosterone • angiotensin • atrial natriuretic peptide • calcium antagonist • coronary artery bypass grafting • diltiazem • open heart surgery • renal function • renin
Submitted on June 16, 1994
Accepted on September 21, 2007
This article has been cited by other articles:
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  S. Manabe, H. Tanaka, T. Yoshizaki, N. Tabuchi, H. Arai, and M. Sunamori Effects of the Postoperative Administration of Diltiazem on Renal Function After Coronary Artery Bypass Grafting Ann. Thorac. Surg., March 1, 2005; 79(3): 831 - 835. [Abstract] [Full Text] [PDF]
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 D. N. Wijeysundera, W. S. Beattie, V. Rao, and J. Karski Calcium antagonists reduce cardiovascular complications after cardiac surgery: A meta-analysis J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1496 - 1505. [Abstract] [Full Text] [PDF]
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 S. N. Piper, B. Kumle, W. H. Maleck, A.-H. Kiessling, A. Lehmann, K. D. Rohm, S. W. Suttner, and J. Boldt Diltiazem may preserve renal tubular integrity after cardiac surgery: [Le diltiazem peut preserver l'integrite tubulaire renale a la suite d'une intervention cardiaque] Can J Anesth, March 1, 2003; 50(3): 285 - 292. [Abstract] [Full Text] [PDF]
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 D. Amar and M. Fleisher Diltiazem Treatment Does Not Alter Renal Function After Thoracic Surgery Chest, May 1, 2001; 119(5): 1476 - 1479. [Abstract] [Full Text] [PDF]
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