Zeiner Andrea, Sunder-Plassmann Gere, Sterz Fritz, Holzer Michael, Losert Heidrun, Laggner Anton N, Müllner Marcus
Department of Emergency Medicine, University of Vienna-Medical School, Vienna, Austria.
Resuscitation. 2004 Mar;60(3):253-61. doi: 10.1016/j.resuscitation.2003.11.006.
Mild therapeutic hypothermia (MTH) improves neurological outcome in patients after cardiac arrest. From animal and human studies it appears that hypothermia impairs renal function. The aim of this study was to examine the effects of MTH on renal function in humans.
Patients were participants recruited in one of the centres of the hypothermia after cardiac arrest-multicenter trial. We measured serum creatinine and creatinine clearance (C(Cr)) within 24 h of MTH, at 4 hourly intervals. Patients were followed for acute renal failure and need for renal supportive therapy for 28 days.
We included 60 patients (32 hypothermic, 28 normothermic). Median serum creatinine on admission was [[119 micromol/l (IQR 108-133)] [1.35 mg/dl (IQR 1.22-1.50)]] in hypothermic and [[114 micromol/l (IQR 99-131)] [1.29 mg/dl (IQR 1.12-1.48)]] in normothermic patients, and decreased to [[69 micromol/l (IQR 62-84)] [0.78 mg/dl (IQR 0.70-0.95)]] in the hypothermic group and to [[88 micromol/l (IQR 71-123)] [1.00 mg/dl (IQR 0.80-1.39)]] in the normothermic group within 24h. C(Cr) was decreased on admission. Within 24 h C(Cr) improved to normal values in normothermic patients [1.53 ml/s (IQR 1.15-2.35) [92 ml/min (IQR 69-141)]] and remained low in hypothermic patients [0.88 ml/s (IQR 0.63-1.38) [53 ml/min (IQR 38-83)]] (P = 0.0006). No difference was found between the groups in the development of acute renal failure or the need for renal supportive therapy.
Twenty four hours of MTH was associated with a delayed improvement in renal function. This was not reflected in the serum creatinine values, which were low in the hypothermic group. This transient impaired renal function appeared to be completely reversible within 4 weeks.
