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Nephrology intervention to avoid acute kidney injury in patients awaiting cardiac surgery: randomized clinical trial
Sergi Codina1,2, Laia Oliveras1,2, Eva Ferreiro1
1Nephrology, Hospital de Bellvitge, Barcelona, Spain.
Insights
Nephrologist intervention before cardiac surgery did not reduce acute kidney injury (AKI). This study found no significant differences in AKI incidence, mortality, or renal function between intervention and standard care groups.
Area of Science:
- Nephrology
- Cardiology
- Critical Care Medicine
Background:
- Cardiac surgery-associated acute kidney injury (CSA-AKI) is a significant complication, increasing patient morbidity and mortality.
- Proactive nephrologist involvement aims to mitigate risks associated with CSA-AKI.
Purpose of the Study:
- To evaluate the effectiveness of nephrologist intervention in reducing CSA-AKI in patients awaiting cardiac surgery.
- To assess the impact of pre-operative nephrology care on patient outcomes.
Main Methods:
- A single-center, open-label, randomized clinical trial involving 380 patients scheduled for cardiac surgery.
- An intervention group received pre-operative nephrologist evaluation one month prior to surgery.
- Data on CSA-AKI incidence, mortality, ICU stay, and renal function were collected.
Main Results:
- No statistically significant difference in CSA-AKI incidence between the intervention (26.37%) and standard care (25.13%) groups (p=0.874).
- Mortality rates (3.91% vs. 3.59%), ICU length of stay, and one-year renal function (eGFR) were similar between groups.
- A non-significant trend towards reduced blood transfusions was noted in the intervention group (p=0.155).
Conclusions:
- Pre-operative nephrologist intervention for all patients on the cardiac surgery waiting list did not demonstrate a nephroprotective benefit.
- Further research may be needed to identify specific patient subgroups who could benefit from such interventions.
Introduction:
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a well-known complication that increases morbidity and mortality rates. The objective of this study was to reduce CSA-AKI through nephrologist intervention in patients awaiting cardiac surgery.
Methods:
We performed a single center, open-label, randomized clinical trial including 380 patients who underwent scheduled cardiac surgery at the Hospital de Bellvitge between July 2015 and October 2019. A total of 184 patients were evaluated by the same Nephrologist one month before the surgery to minimize the risk factors for AKI. In addition to assessments at the outpatient clinic, we also collected clinical data during hospitalization and during the first year.
Results:
Despite the intervention, no differences were observed between the groups in the incidence of CSA-AKI (intervention group 26.37% vs. standard of care 25.13%, p=0.874), mortality (3.91% vs. 3.59%, p=0.999), length of Intensive Care Unit (ICU) stay (10 days [7.00;15.0] for both groups, p=0.347), or renal function after one year of follow-up (estimated glomerular filtration rate (eGFR) by CKD-EPI: 74.5 ml/min (standard deviation 20.6) vs 76.7 (20.8) ml/min, respectively, p=0.364). A reduction in the need for blood transfusion was observed in the intervention group, although the difference was not statistically significant (37.22% vs. 45.03%, p =0.155).
Conclusion:
In this clinical trial, nephrologist intervention in the entire population on the cardiac surgery waiting list did not show a nephroprotective benefit.
Clinical Trial Registration:
ClinicalTrials.gov, identifier (NCT02643745).
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