Uric acid and acute kidney injury in high-risk patients for developing acute kidney injury undergoing cardiac surgery: A prospective multicenter study.

PURPOSE: It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI. DESIGN: Multicenter prospective international cohort study. SETTING: Fourteen university hospitals in Spain and the United Kingdom. PARTICIPANTS: We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥ 4 points, from July to December 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7 mg/dL) and AKI. Elevated preoperative AUS (≥7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; P = .17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, P = .37). CONCLUSIONS: Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.

[0.0625% bupivacaine compared with 0.125% bupivacaine continuously perfused epidurally during vaginal delivery]. / Bupivacaína al 0.0625% comparada con bupivacaína al 0.125% en perfusión continua por vía epidural en parto vaginal.

BACKGROUND: The effects of two continuous epidural perfusions of bupivacaine at different small concentrations on maternal analgesia, motor paralysis, the progress of delivery and the newborn were compared. PATIENTS AND METHODS: Forty primigravida patients were divided into two homogeneous groups, A and B, with 20 patients in each. Group A patients were administered a perfusion of bupivacaine at 0.625% and those of group B received a perfusion of bupivacaine at 0.125%. Both perfusions were administered at 10 mg/hour. The following variables were collected: analgesia (visual analogic scale), time of perfusion, local anesthetic doses, re-injections, tenesmus, APGAR at the first minute, APGAR at 5 minutes, use of forceps and motor paralysis. RESULTS: The perfusion of bupivacaine 0.125% (group B) was more effective in the control of pain since no re-injections were required in this group. The time of perfusion and delivery was significantly less (p < 0.05) in group B (2.95 +/- 0.74 hours) than in group A (3.42 +/- 0.62 hours). There were no significant differences in the total dose (group A: 55.9 +/- 14.09 mg and group B 57.47 +/- 9.06 mg), tenesmus and APGAR: Instrumentation during delivery carried out in both groups (55% in group A and 30% in group B) was at the limits of significance (p = 0.057). Motor paralysis of the lower limbs did not surpass the value of 1 of the modified Bromage scale in either group. CONCLUSIONS: Both techniques (continuous perfusion of bupivacaine at 0.0625% versus bupivacaine at 0.125%) are effective in the control of pain during the second stage of labour with the perfusion of the latter dose (12.5 mg/hour) being more advantageous by diminishing the length of delivery and achieving continuous analgesia.