A Single-Center Randomized Trial of Intraoperative Zero-Balanced Ultrafiltration During Cardiopulmonary Bypass for Patients With Impaired Kidney Function Undergoing Cardiac Surgery.

Abstract

OBJECTIVES:

The authors investigated whether zero-balance ultrafiltration (Z-BUF) during bypass significantly improves clinical and cost outcomes or biomarkers of kidney injury for patients with preoperative kidney impairment (estimated glomerular filtration rate [eGFR]<60 mL/minute) undergoing cardiac surgery.

DESIGN:

A single-center randomized controlled trial recruited, patients between 2010 and 2013, with a 12-months follow-up.

SETTING:

Hospital.

PARTICIPANTS:

One hundred ninety-nine patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).

INTERVENTIONS:

Patients were assigned randomly to receive zero-balance ultrafiltration (Z-BUF) or not, with stratification for degree of kidney dysfunction and diabetes.

MEASUREMENTS AND MAIN RESULTS:

The authors assessed clinical efficacy and kidney function biomarkers. Cumulative probability of discharge from the intensive care unit (ICU) was assessed by Kaplan-Meier plots and was found not to be significantly different between the two trial arms (p = 0.61). After adjusting for EuroSCORE, diabetes, eGFR, cardioplegia types and type of surgery in a Cox proportional hazard model, hazard ratios (HR) for ICU length of stay between the Z-BUF and no-Z-BUF groups was not significantly different: HR (95% CI): 0.89 (0.66, 1.20; p = 0.44). In contrast, significant reductions in postoperative chest infections and the composite of clinical endpoints (death, strokes, and myocardial infarctions) in the Z-BUF group were observed. In addition, Z-BUF significantly abrogated the rise in the kidney damage markers urinary NGAL/creatinine ratio, urea, creatinine and eGFR during CPB and adverse events risks.

CONCLUSIONS:

Z-BUF during bypass surgery is associated with significant reductions in morbidity and biomarkers of CPB-induced acute kidney injury soon after CPB, which are indicative of clearance of inflammatory/immune mediators from the circulation.

• Authors: Bashir M Matata, Nigel Scawn, Maureen Morgan, Sarah Shirley, Ian Kemp, Sarah Richards, Steven Lane, Keith Wilson, Rodney Stables, Mark Jackson, Alan Haycox, Neeraj Mediratta
• Journal: Journal of cardiothoracic and vascular anesthesia (J Cardiothorac Vasc Anesth) Vol. 29 Issue 5 Pg. 1236-47 (Oct 2015) ISSN: 1532-8422 [Electronic] United States
• PMID: 26119403 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Topics

• Acute Kidney Injury (epidemiology, etiology, prevention & control)
• Aged
• Aged, 80 and over
• Cardiac Surgical Procedures
• Cardiopulmonary Bypass
• Coronary Artery Disease (complications, surgery)
• Female
• Follow-Up Studies
• Glomerular Filtration Rate
• Humans
• Intraoperative Period
• Male
• Middle Aged
• Morbidity (trends)
• Renal Insufficiency (complications, therapy)
• Retrospective Studies
• Single-Blind Method
• Ultrafiltration (methods)
• United Kingdom (epidemiology)