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Elevated Cardiopulmonary Bypass Flow for Renal Protection in Cardiac Surgery: A Randomized Trial
Johanna Wijk1, Anna Corderfeldt-Keiller2,3, Bengt Redfors1
1From the Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Section of Cardiothoracic Anaesthesia and Intensive Care.
Anesthesia and Analgesia
|August 10, 2026
Summary
Increasing cardiopulmonary bypass (CPB) flow by 20% significantly reduced kidney injury biomarkers and improved early hemodynamic stability in patients undergoing cardiac surgery. This intervention may attenuate acute kidney injury (AKI) after CPB.
Area of Science:
- Cardiology
- Nephrology
- Surgical Critical Care
Background:
- Acute kidney injury (AKI) is a significant complication following cardiac surgery with cardiopulmonary bypass (CPB).
- Limited clinical data exist on optimizing CPB flow to enhance renal oxygenation and prevent AKI.
- Experimental studies suggest higher CPB flow may improve renal perfusion.
Purpose of the Study:
- To investigate the hypothesis that increasing CPB flow attenuates renal injury and improves organ perfusion.
- To evaluate the impact of high-flow CPB on renal injury biomarkers and postoperative kidney function.
Main Methods:
- A single-center randomized controlled trial involving 89 adult patients undergoing elective cardiac surgery.
- Patients were allocated to either high-flow (2.9 L·min·m-2) or standard-flow (2.4 L·min·m-2) CPB.
- Primary outcomes included urine biomarkers of renal injury (NAG, TIMP-2 × IGFBP-7); secondary outcomes included serum creatinine, AKI incidence, and hemodynamic parameters.
Main Results:
- High-flow CPB significantly reduced urine biomarkers of renal injury (NAG and TIMP-2 × IGFBP-7) compared to standard-flow.
- Median serum creatinine remained below baseline postoperatively in the high-flow group, unlike the standard-flow group.
- While AKI incidence was lower in the high-flow group (16% vs. 25%), the difference was not statistically significant (P = .248).
- Norepinephrine requirements were significantly reduced in the high-flow group.
Conclusions:
- Increasing CPB flow by 20% effectively reduced renal injury biomarkers and improved early postoperative creatinine levels.
- The intervention also enhanced early hemodynamic stability, indicated by reduced vasopressor use.
- Further large-scale, multicenter trials are warranted to confirm these findings and identify specific patient populations who benefit most from high-flow CPB.