Effects of Ulinastatin on Postoperative Renal Function in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass: A Prospective Cohort Study with 10-Year Follow-Up.

Introduction: The present study aimed to explore the potential effect of ulinastatin on renal function and long-term survival in patients receiving cardiac surgery with CPB. Methods: This prospective cohort study was conducted at Fuwai Hospital, Beijing, China. The ulinastatin was applied after induction anesthesia. The primary outcome was the rate of new-onset postoperative acute kidney injury (AKI). Moreover, a ten-year follow-up was conducted until Jan 2021. Results: The rate of new-onset AKI was significantly lower in the ulinastatin group than in the control group (20.00% vs. 32.40%, p=0.009). There was no significant difference in RRT between the two groups (0.00% vs. 2.16%, p=0.09). The postoperative pNGAL and IL-6 levels were significantly lower in the ulinastatin group compared with the control group (pNGAL: p=0.007; IL-6: p=0.001). A significantly lower incidence of respiratory failure in the ulinastatin group compared with the control group (0.76% vs. 5.40%, p=0.02). The nearly 10-year follow-up (9.37,95CI%:9.17-9.57) survival rates did not differ significantly between the two groups (p=0.076). Conclusions: Ulinastatin significantly reduced postoperative AKI and respiratory failure in patients receiving cardiac surgery with CPB. However, ulinastatin did not reduce ICU and hospital stay, mortality, and long-term survival rate.