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Reduction in acute kidney injury post cardiac surgery using balanced forced diuresis: a randomized, controlled trial
Luckraz, Heyman Giri, Ramesh Wrigley, Benjamin Nagarajan, Kumaresan Senanayake, Eshan Sharman, Emma Beare, Lawrence Nevill, Alan
Luckraz, Heyman
Giri, Ramesh
Wrigley, Benjamin
Nagarajan, Kumaresan
Senanayake, Eshan
Sharman, Emma
Beare, Lawrence
Nevill, Alan
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2020-11-25
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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 < 0.001). There were no significant differences in the incidence of blood transfusions, atrial fibrillation and infections and in the median duration of intensive care unit stays between the groups. The number needed to treat with the RG system to prevent AKI was 9 patients (95% confidence interval 6.0–19.2). CONCLUSIONS In patients at risk for AKI who had cardiac surgery with CPB, the RS RG system significantly reduced the incidence of AKI and can be used safely and reproducibly. Larger studies are required to confirm cost benefits.
Citation
Luckraz, H., Giri, R., Wrigley, B., Nagarajan, K., Senanayake, E., Sharman, E., Beare, L. and Nevill, A. (2020) Reduction in acute kidney injury post cardiac surgery using balanced forced diuresis: a randomized, controlled trial, European Journal of Cardio-Thoracic Surgery. https://doi.org/10.1093/ejcts/ezaa395
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Journal article
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en
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© 2020 The Authors. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. 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/10.1093/ejcts/ezaa395
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1010-7940
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1873-734X
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This work was supported by RenalGuard Solutions; and National Institute of Healthcare Research (NIHR), Clinical Research Network, UK [Ref: NIHR CRN No 32769].