Background.: Preoperative fasting induces robust protection against renal ischemia/reperfusion (I/R) injury in mice but is considered overcautious and possibly detrimental for postoperative recovery in humans. Furthermore, fasting seems to conflict with reported benefits of preoperative nutritional enhancement with carbohydrate-rich drinks. Here, we investigated whether preoperative ingestion of a glucose solution interferes with fasting-induced protection against renal I/R injury. Methods.: Mice were randomized into the following groups: fasted for 3 days with access to water (fasted) or a glucose solution (fasted+glc) and fed ad libitum with water (fed) or a glucose solution (fed+glc). After induction of bilateral renal I/R injury, all animals had free access to food and water. Calorie intake, body weight, insulin sensitivity, kidney function, and animal survival were determined. Results.: Fed+glc mice had a comparable daily calorie intake as fed mice, but 50% of those calories were obtained from the glucose solution. Fasted+glc mice had a daily calorie intake of approximately 75% of the intake of both fed groups. This largely prevented the substantial body weight loss seen in fasted animals. Preoperative insulin sensitivity was significantly improved in fasted+glc mice versus fed mice. After I/R injury, kidney function and animal survival were superior in both fasted groups. Conclusions.: The benefits of fasting and preoperative nutritional enhancement with carbohydrates are not mutually exclusive and may be a clinically feasible regimen to protect against renal I/R injury.

, , , , ,
doi.org/10.1097/TP.0b013e31822c6ed7, hdl.handle.net/1765/30772
Transplantation
Erasmus MC: University Medical Center Rotterdam

Verweij, M., van de Ven, M., Mitchell, J., van den Engel, S., Hoeijmakers, J., IJzermans, J., & de Bruin, R. (2011). Glucose supplementation does not interfere with fasting-induced protection against renal ischemia/reperfusion injury in Mice. Transplantation, 92(7), 752–758. doi:10.1097/TP.0b013e31822c6ed7