Diltiazem may preserve renal tubular integrity after cardiac surgery

Can J Anaesth. 2003 Mar;50(3):285-92. doi: 10.1007/BF03017799.


Purpose: To evaluate the influence of dopamine and diltiazem on renal function and markers for acute renal failure, including urinary alpha-glutathion s-transferase (alpha-GST), alpha-1-microglobulin (alpha(1)-MG) and N-acetyl-ss-glucosaminidase (ss-NAG) after extracorporeal circulation.

Methods: In a randomized, placebo-controlled, double-blind trial we evaluated the efficacy of dopamine (2.5 micro g x kg(-1) x min(-1)), diltiazem (2 micro g x kg(-1) x min(-1)) or placebo administered over 48 hr postoperatively to maintain renal tubular integrity in 60 elective cardiac surgery patients. alpha-GST, alpha(1)-MG, ss-NAG, and creatinine clearance were measured from urine collected during surgery (T0), the first four hours (T1), 24 hr (T2) and 48 hr (T3) postoperatively.

Results: Cumulative urine output in the diltiazem group (9.0 +/- 2.8 L) increased significantly compared with placebo (7.0 +/- 1.6 L), but not compared with dopamine (7.8 +/- 1.8 L). Creatinine clearance showed no significant intergroup differences. In all groups alpha(1)-MG increased from T0 to T3, but we found no significant intergroup differences. alpha-GST increased significantly from T0 to T3 in the placebo (2.1 +/- 1.8 to 11.4 +/- 8.6 micro g x L(-1)) and in the dopamine groups (2.7 +/- 1.8 to 13.6 +/- 14.9 micro g x L(-1)), but not in the diltiazem group (1.8 +/- 1.4 to 3.2 +/- 3.2 micro g x L(-1)). Forty-eight hours postoperatively alpha-GST was significantly lower in the diltiazem group than in both other groups.

Conclusions: Diltiazem stimulates urine output, reduces excretion of alpha-GST and ss-NAG and may be useful to maintain tubular integrity after cardiac surgery.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Retracted Publication

MeSH terms

  • Acetylglucosaminidase / urine
  • Acute Kidney Injury / prevention & control*
  • Adult
  • Aged
  • Calcium Channel Blockers / pharmacology*
  • Cardiac Surgical Procedures / adverse effects*
  • Cardiopulmonary Bypass
  • Diltiazem / pharmacology*
  • Diuresis / drug effects
  • Dopamine / pharmacology
  • Double-Blind Method
  • Female
  • Glutathione Transferase / urine
  • Humans
  • Kidney Tubules / drug effects*
  • Male
  • Middle Aged


  • Calcium Channel Blockers
  • Glutathione Transferase
  • Acetylglucosaminidase
  • Diltiazem
  • Dopamine