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Balanced forced-diuresis compared to control as a reno-protective approach in cardiac surgery: Secondary outcome of a randomized controlled trial, assessment of neutrophil gelatinase-associated lipocalin levels
- Source :
- Journal of Cardiothoracic Surgery, Vol 16, Iss 1, Pp 1-7 (2021), Journal of Cardiothoracic Surgery
- Publication Year :
- 2021
- Publisher :
- Research Square Platform LLC, 2021.
-
Abstract
- Background Neutrophil gelatinase-associated lipocalin (NGAL) is a recognised biomarker for acute kidney injury (AKI).This study investigated the impact of balanced forced-diuresis using RenalGuard® system (RG), in reducing acute kidney injury (AKI) rates and the associated NGAL levels (6-h post-CPB plasma level) post adult cardiac surgery with cardiopulmonary bypass (CPB). Methods Patients included in the study were at high-risk for AKI post cardiac surgery, namely history of diabetes and/or anaemia, e-GFR 20–60 ml/min/1.73 m2, Logistic EuroScore > 5, anticipated CPB time > 120 min. Patients were randomized to either RG (n = 110) or managed as per current practice (control = 110). RIFLE-defined AKI rate (based on serum creatinine level increase) within first 3 days of surgery and 6-h post CPB NGAL levels were the primary and secondary end-points. Results Pre and intra-operative characteristics between the two groups were similar (p > 0.05) including the pre-op NGAL levels, the oxygen delivery (ecDO2i) and the carbon dioxide production (ecVCO2i) during CPB. Patients in the RG group had a significantly lower post-operative RIFLE-defined AKI rate compared to control (10% (11/110) v/s 20.9% (23/110), p = 0.03). Overall, median 6-h post CPB NGAL levels in patients with AKI were significantly higher than those who did not develop AKI (211 vs 150 ng/ml, p Conclusions Overall, the 6-h post-CPB plasma NGAL levels were significantly higher in patients who developed AKI. Patients managed with the novel approach of balanced forced-diuresis, provided by the RenalGuard® system, had a lower AKI rate and lower NGAL levels indicating a lesser degree of renal tissue injury. Trial registration ClinicalTrials.gov website, NCT02974946, https://clinicaltrials.gov/ct2/show/NCT02974946.
- Subjects :
- Adult
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Balanced forced-diuresis
RD1-811
Forced diuresis
law.invention
Secondary outcome
Lipocalin-2
Randomized controlled trial
Predictive Value of Tests
law
Anesthesiology
Proto-Oncogene Proteins
Internal medicine
medicine
Humans
RD78.3-87.3
Cardiac Surgical Procedures
Neutrophil gelatinase-associated lipocalin
RenalGuard® system
business.industry
General Medicine
Creative commons
Cardiac surgery
Lipocalins
Diuresis
Acute kidney injury
Cardiothoracic surgery
Creatinine
Surgery
Cardiology and Cardiovascular Medicine
business
Biomarkers
Acute-Phase Proteins
Research Article
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Journal of Cardiothoracic Surgery, Vol 16, Iss 1, Pp 1-7 (2021), Journal of Cardiothoracic Surgery
- Accession number :
- edsair.doi.dedup.....3987693d8eb7625fed27b02fa6d2f8db