1. Reduction in acute kidney injury post cardiac surgery using balanced forced diuresis: a randomized, controlled trial
- Author
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Emma Sharman, Eshan Senanayake, Lawrence Beare, Kumaresan Nagarajan, Alan M. Nevill, Heyman Luckraz, Benjamin Wrigley, and Ramesh Giri
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,030232 urology & nephrology ,Renal function ,030204 cardiovascular system & hematology ,system ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,law ,RenalGuard® ,Risk Factors ,Cardiopulmonary bypass ,Medicine ,Humans ,Eacts/118 ,Cardiac Surgical Procedures ,Retrospective Studies ,Cardiopulmonary Bypass ,business.industry ,AcademicSubjects/MED00920 ,Acute kidney injury ,General Adult Cardiac ,EuroSCORE ,General Medicine ,Odds ratio ,Cardiac surgery ,Acute Kidney Injury ,medicine.disease ,Intensive care unit ,Diuresis ,Anesthesia ,Number needed to treat ,Surgery ,Eacts/105 ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES Our goal was to investigate the efficacy of balanced forced diuresis in reducing the rate of acute kidney injury (AKI) in cardiac surgical patients requiring cardiopulmonary bypass (CPB), using the RenalGuard® (RG) system. METHODS Patients at risk of developing AKI (history of diabetes and/or anaemia; estimated glomerular filtration rate 20–60 ml/min/1.73 m2; anticipated CPB time >120 min; log EuroSCORE > 5) were randomized to the RG system group (n = 110) or managed according to current practice (control = 110). The primary end point was the development of AKI within the first 3 postoperative days as defined by the RIFLE (Risk, Injury, Failure, Loss of kidney function, End-stage renal disease) criteria. RESULTS There were no significant differences in preoperative and intraoperative characteristics between the 2 groups. Postoperative AKI rates were significantly lower in the RG system group compared to the control group [10% (11/110) vs 20.9% (23/110); P = 0.025]. This effect persisted even after controlling for a number of potential confounders (odds ratio 2.82, 95% confidence interval 1.20–6.60; P = 0.017) when assessed by binary logistic regression analysis. The mean volumes of urine produced during surgery and within the first 24 h postoperatively were significantly higher in the RG system group (P, Acute kidney injury (AKI) after cardiac surgery is well documented [1].
- Published
- 2020