Balanced forced‐diuresis as a renal protective approach in cardiac surgery: Secondary outcomes of electrolyte changes
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AbstractObjectives Forced-diuresis during cardiopulmonary bypass (CPB) can be associated with significant electrolyte shifts. This study reports on the serum electrolyte changes during balanced forced-diuresis with the RenalGuard® system (RG) during CPB. Methods Patients at risk of acute kidney injury (AKI)—(history of diabetes &/or anaemia, e-GFR 20–60 ml/min/1.73 m2, anticipated CPB time >120 min, Log EuroScore >5)—were randomized to either RG (study group) or managed as per current practice (control group). Results The use of RG reduced AKI rate (10% for RG and 20.9% in control, p = .03). Mean urine output was significantly higher in the RG group during surgery (2366 ± 877 ml vs. 765 ± 549 ml, p < .001). The serum potassium levels were maintained between 3.96 and 4.97 mmol/L for the RG group and 4.02 and 5.23 mmol/L for the controls. Median potassium supplemental dose was 60 (0–220) mmol (RG group) as compared to 30 (0–190) mmol for control group over first 24 h (p < .001). On Day 1 post-op, there were no significant differences in the serum sodium, potassium, calcium, magnesium, phosphate, and chloride levels between the two groups. Otherwise, postoperative clinical recovery was also similar. Conclusions Balanced forced-diuresis with the RG reduced AKI rates after on-pump cardiac surgery compared to controls. Although the RG group required higher doses of IV potassium replacement in the postoperative period, normal serum levels of potassium were maintained by appropriate intravenous potassium supplementation and the clinical outcomes between groups were similar.
CitationLuckraz H, Giri R, Wrigley B, et al. Balanced forced‐diuresis as a renal protective approach in cardiac surgery: Secondary outcomes of electrolyte changes. Journal of Cardiac Surgery, 2021; pp. 1‐7. https://doi.org/10.1111/jocs.15925
JournalJournal of Cardiac Surgery
Description© 2021 The Authors. Published by Wiley. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1111/jocs.15925
SponsorsThis work was supported by a research grant from RenalGuard Solutions and by the National Institute of Healthcare Research (NIHR), Clinical Research Network, UK (Ref: NIHR CRN No 32769)
Except where otherwise noted, this item's license is described as https://creativecommons.org/licenses/by/4.0/