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Goal-directed perfusion to reduce acute kidney injury: A randomized trial.

Authors :: Ranucci M
Johnson I
Willcox T
Baker RA
Boer C
Baumann A
Justison GA
de Somer F
Exton P
Agarwal S
Parke R
Newland RF
Haumann RG
Buchwald D
Weitzel N
Venkateswaran R
Ambrogi F
Pistuddi V
Source :: The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2018 Nov; Vol. 156 (5), pp. 1918-1927.e2. Date of Electronic Publication: 2018 Apr 18.
Publication Year :: 2018
Abstract: Objective: To determine whether a goal-directed perfusion (GDP) strategy aimed at maintaining oxygen delivery (DO <subscript>2</subscript> ) at ≥280 mL·min <superscript>-1</superscript> ·m <superscript>-2</superscript> reduces the incidence of acute kidney injury (AKI).<br />Methods: This multicenter randomized trial enrolled a total of 350 patients undergoing cardiac surgery in 9 institutions. Patients were randomized to receive either GDP or conventional perfusion. A total of 326 patients completed the study and were analyzed. Patients in the treatment arm were treated with a GDP strategy during cardiopulmonary bypass (CPB) aimed to maintain DO <subscript>2</subscript> at ≥280 mL·min <superscript>-1</superscript> ·m <superscript>-2</superscript> . The perfusion strategy for patients in the control arm was factored on body surface area and temperature. The primary endpoint was the rate of AKI. Secondary endpoints were intensive care unit length of stay, major morbidity, red blood cell transfusions, and operative mortality.<br />Results: Acute Kidney Injury Network (AKIN) stage 1 was reduced in patients treated with GDP (relative risk [RR], 0.45; 95% confidence interval [CI], 0.25-0.83; P = .01). AKIN stage 2-3 did not differ between the 2 study arms (RR, 1.66; 95% CI, 0.46-6.0; P = .528). There were no significant differences in secondary outcomes. In a prespecified analysis of patients with a CPB time between 1 and 3 hours, the differences in favor of the treatment arm were more pronounced, with an RR for AKI of 0.49 (95% CI, 0.27-0.89; P = .017).<br />Conclusions: A GDP strategy is effective in reducing AKIN stage 1 AKI. Further studies are needed to define perfusion interventions that may reduce more severe levels of renal injury (AKIN stage 2 or 3).<br /> (Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)