The Effect of Hemoconcentration on Kidney Function (Essay Sample)

Running Head: THE EFFECT OF HEMOCONCENTRATION ON KIDNEY FUNCTION
The Effect of Hemoconcentration on Kidney Function: A Meta-Analysis
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The Effect of Hemoconcentration on Kidney Function: A Meta-Analysis
Introduction
The common belief that hemoconcentrators may adversely affect kidney function and therefore some of the current practices are in debate whether a hemoconcentrator should be used on Cardiopulmonary Bypass (CPB). CPB essentially is a means of substituting the function of the heart and lungs. The patient's circulation is to be diverted through a heart-lung machine called the pump with an oxygenator. This heart-lung machine preserves the blood supply to vital organs while the heart is being stopped, and surgery is being performed. When coronary bypass graft is performed, CPB is used to support the systemic circulation, typically for 60-90 minutes while the critical grafts are constructed to the coronary arteries. But there is a price to pay for the assistance of the CPB. While CPB allows surgeons to perform CABG surgeries on "a motionless target and a bloodless environment" (Lorenz & Coyte, 2002), this technological advance was fraught with risk of complications. Documented complications include an array of cellular and humoral immunologic responses including triggering the inflammatory chain of events and blood activation/damage (Unsworth-White, 2005).
Patient diagnoses, physiological conditions, and physical specifics vary’ widely. For each patient the management of the heart-lung machine, anesthetic practice, and surgical procedures are individually tailored. Protocol is then modified on a second by second basis during the course of the surgery as information becomes available or additional problems become apparent. These modifications may or may not be recorded in the surgical record. Patient monitoring instruments available in the operating room are designed for easy visibility to convey information to the surgical team and are not always convenient for automated data acquisition. The data output ports which are available from these instruments are not standardized if they are even available. Most importantly, the safety of the patient must be considered with regard to every action performed. Thus, the use of hemoconcentrators, its important role and chracteristic on renal function and kidney injury will be investigated through meta-analysis.
Purpose of study
The purpose of this thesis is to prove and show whether hemoconcentrator adversely affects renal function.
Statement of Research Problem
The overarching research problem in this meta-analysis is “What are the effecs of hemoconcentration on kidney function for patients using hemoconcentrators during bypass pre and post-surgery compared to those not using a hemoconctrator during surgery?
Literature Review
This literature review explores other research that was published about the inflammatory effect induced by CPB surgery on Kidney functions. First, it focuses on establishing a relevant background for this study. While accepting the inability of some literature to directly address the issues surrounding extra-corporeal circuitry, a focus on literature that establishes relevancy between the extracorporeal circuitry and systems theory is maintained. Second, it then establishes existing problems pertaining to CPB surgery and in some instances related clinical procedures. Underpinning the many studies reviewed, are findings covering almost all types of clinical surgery, yet relevant to this study. This is necessary due in part to the role of CPB surgery, which constitutes a vital component of clinical cardiac surgery and incorporates both the technology and procedures that is found in many other types of clinical surgeries. For almost half of the current century, CPB surgery has not only been a preferred methodology for multiple cardiac indications, but also in various non-cardiac indications (Nair, Lawrence, Punjabi, & Taylor, 2012). More recently, CPB surgery equipment has revolutionized clinical practice, facilitating surgeons to perform increasingly multifarious cardiac as well as other exigent operations (Cohen, 2013).
The patients of CPB surgery receive support from its tracheal procedures thereby facilitating assistance in breathing. The application of CPB surgery is potentially coupled with pulmonary physio-pathological insults or invasive attacks. These combinations result from severe trauma, potentially leading to respiratory and renal failure indicated within the postoperative setting (Clark, 2006). From the 1950s, CPB surgery has been used as a routine procedures in the cardiac surgical operations since being introduced as a viable clinical methodology. However, this surgical procedure is allied or associated with a concentrated inflammatory response due to a change in the flow of laminar, contact of blood with an artificial surface of bypass equipment, hypothermia and cardiac ischemia. This inflammatory response is seen as a pervasive concentrated opponent due to its ability to generate and activate various inflammatory mediators, adhesion molecules cytokines, thrombin, mast cells and neutrophils through various pathways, all due to multifaceted cellular and humoral interfaces. Such inflammatory response can achieve maximum concentration thereby generating and activating a renal failure. This failure was connected with not only serious morbidity, but also mortality (Larmann & Theilmeier, 2004).
In addition, attempts have been enacted so that this inflammatory response would be suppressed with the help of drafting various strategies, and although albeit a measure of success was achieved, such attempts failed to prevent or deter the invasion of this inflammatory response into the patient’s defensive mechanism. The development of such attempts in part have been directed to “limiting the blood-air interface, decreasing the surface area of artificial material, and optimizing the surface coating of components” (Vohra, Whistance, Modi, & Ohri, 2009, p. 1).
Despite the numerous factors that were involved in such a variable defensive environment, large numbers of therapeutic approaches have been taken under consideration in order to check their potential in decreasing the inflammatory response within clinical surgery. These therapeutic intrusions include, but are not limited to, issues such as leukocyte depletion, steroids, protease inhibitors, antioxidants, heparin-coated bypass circuits and the ability to complement inhibition by monoclonal antibodies and modified ultra-hemofiltration (Larmann & Theilmeier, 2004) to the counter-inflammatory properties of agents and drugs characterized as immunomodulatory, their ability to affect a measure of control; perhaps result in the attainment of a more potentially beneficial resolution. According to Laffey et al. (2002), inflamatory response to various organs such as the kidney, can be controlled and self-limiting (p. 228); thereby enhancing or priming the body’s immunity towards inflammation. In turn, according to the above data; this process facilitates a defense against infection and enables the healing process of tissue wounds; perhaps enabling the return of an organ to its original healthy function both during the perioperative or postoperative environment.
In addition, this beneficial function can be viewed as therapeutic, seen within the context of a positive clinical outcome. Despite the possibility of this positive outcome, there is still a strong likelihood of an inflammatory response to negatively impacting the ability of the organ such as the kidney, to its original functionality or operating function, thereby further validating the Hemoconcentrator’s role as an attenuator of an inflammatory response. However, problems arise when quantifying the severity of the inflammatory response, creating difficulties when categorizing it as a significant factor within clinical surgery (Skrabal et al., 2006).
Measuring the Hemonconcentrator’s ability to attenuate inflammatory reactions is challenging if there are pre-existing issues contributing to the existence of a renal failure. Strohmeyer et al. (2003) concludes that difficulties arise when verifying those at high risk due to pre-existing conditions, such as issues associated with organ dysfunction or organ failure, since confounding factors such as old age also can contribute to an inflammatory response and its severity. However, studies predicting the likelihood of infections that were associated with a kidney function can be determined by means of monitoring (Strohmeyer et al. 2003). Their findings indicate that new markers can be used to enable the prediction of a clinical recovery. Due to more recent advances in clinically based technology, immuno-diagnostic equipment and techniques have become a standardized approach to the detection of inflammatory responses; thereby facilitating the measurement of the Hemoconcentrator’s reduction in renal failure. According to Strohmeyer et al. (2003), they approached the challenges posed when attempting to proactively predict inflammatory response, by including participants who were perceived to be at ‘high risk,` especially within a post-operative setting. This approach was achieved by monitoring participants who already had preoperative issues such as old age and reduction of heart and kidney functionality. Their objective was to either preoperatively predict the likelihood of severe renal failure. Based on the above method of defining an inflammatory response, ascertaining the Hemoconcentrator’s relevance is thus challenging.
Hypothesis
If Hemoconcentration does not adversely affect renal function, then it should be used freely on CPB.
Materials and Methods
Data sources
Online data source...