Goal-directed perfusion to reduce acute kidney injury: A randomized trial

Abstract

A GDP strategy is effective in reducing AKIN stage 1 AKI. Further studies are needed to define perfusion interventions that may reduce more severe levels of renal injury (AKIN stage 2 or 3).

Strategies that improve renal medullary oxygenation during experimental cardiopulmonary bypass may mitigate postoperative acute kidney injury

“…They also provide a potential mechanistic basis for the recent clinical finding that avoidance of whole body DO 2 < 280 ml kg -1 m -2 on bypass reduced the risk of postoperative AKI. 11 To our knowledge this is the first detailed analysis of the effects of CPB on renal oxygenation in a clinically relevant large animal model. Hypoxia in the renal medulla has previously been reported in a rat model of CPB 7 and in a pilot study of 2 pigs.…”

“…They are also consistent with clinical observations that low pump flow or low whole body DO 2 on CPB is associated with greater incidence of postoperative AKI 9,22,23 and that avoidance of low whole body DO 2 during CPB can reduce the incidence of postoperative AKI. 10,11 Medullary PO 2 was also increased by low-dose infusion of metaraminol to increase MAP from w63 to w90 mm Hg.…”

“…8 However, there have been no systematic investigations of renal global and regional (i.e., cortical and medullary) perfusion and oxygenation in a clinically relevant large animal model of CPB. Furthermore, although evidence shows that goaldirected perfusion can mitigate risk of postoperative AKI [9][10][11] and that the increase in renal fractional oxygen extraction during CPB can be alleviated by increasing pump flow, 12,13 the potential for perfusion conditions to be…”

Reply: Cardiac surgery–associated acute kidney injury—A protective armor rather than a lethal ammunition

“…This is why it is so difficult to exert absolute control over CSA-AKI, which still today remains a notable complication after cardiac surgery, with increased postoperative morbidity and mortality regardless of our tremendous efforts. 4…”

Commentary: Acute kidney injury: The one-million-pieces puzzle

“…Techniques aimed at maximizing renal perfusion are promising, even if there is no evidence that they prevent all AKI stages. 9,10 The unresolved issue of how to prevent AKI lies in wait, as not all of the renal noxae are effectively under the clinician's control. This study foresees an easily implementable tool into the clinical practice, but AKI remains a one-million-pieces puzzle.…”