Goal-directed therapy in patients with early acute kidney injury: a multicenter randomized controlled trial

Abstract

OBJECTIVES:Acute kidney injury is associated with many conditions, and no interventions to improve the outcomes of established acute kidney injury have been developed. We performed this study to determine whether goal-directed therapy conducted during the early stages of acute kidney injury could change the course of the disease.METHODS:This was a multicenter prospective randomized controlled study. Patients with early acute kidney injury in the critical care unit were randomly allocated to a standard care (control) group or a goal-directed therapy group with 8h of intensive treatment to maximize oxygen delivery, and all patients were evaluated during a period of 72h. ClinicalTrials.gov: NCT02414906.RESULTS:A total of 143 patients were eligible for the study, and 99 patients were randomized. Central venous oxygen saturation was significantly increased and the serum lactate level significantly was decreased from baseline levels in the goal-directed therapy group (p=0.001) compared to the control group (p=0.572). No significant differences in the change in serum creatinine level (p=0.96), persistence of acute kidney injury beyond 72h (p=0.064) or the need for renal replacement therapy (p=0.82) were observed between the two groups. In-hospital mortality was significantly lower in the goal-directed therapy group than in the control group (33% vs. 51%; RR: 0.61, 95% CI: 0.37-1.00, p=0.048, number needed to treat=5).CONCLUSIONS:Goal-directed therapy for patients in the early stages of acute kidney injury did not change the disease course.

WITHDRAWN: Role of Acute Kidney Injury in High-Risk Surgical Patients. A Multicenter Prospective Cohort Study.

“…Considering data from the literature, we assumed a renal complication rate of 15% in high-risk surgical patients [4,7,12]. Therefore, we estimated that at least 1,000 patients would be required to conduct the study with the inclusion of fteen explanatory variables in a robust logistic regression model, with 28-day mortality as the dependent variable.…”

“…The subsequent rupture of intercellular junctions leads to the release of cells into the tubular lumen and to polarity loss of the transmembrane ion channel. It is expected that, in many cases, simply restoring the circulating volume does not improve the results and may be counterproductive [4,5]. Elevated intratubular pressure decreases glomerular ltration and activation of tubuloglomerular feedback, with consequent preglomerular vasoconstriction, which leads to an additional reduction in glomerular ltration.…”

“…The development of AKI is commonly associated with sepsis, low cardiac output and the postoperative period of major surgeries [4]. One out of every three cases of AKI occurs during the perioperative period [5]; such cases represent approximately 18 to 47% of the cases of hospital-acquired AKI [6].…”

Exercise as a therapeutic option for acute kidney injury: mechanisms and considerations for the design of future clinical studies

“…Whether the results seen in animal pre-clinical models can be repeated in humans has been discussed previously [37,38]. The promising results of many therapeutics seen in animal AKI models [39][40][41][42][43][44], were unable to be repeated in AKI patients [11][12][13][14][15][16][17][18]45]. This has been explained by numerous factors including the failure of pre-clinical studies to model AKI accurately.…”

Opportunities and Challenges for Interpreting Rare Variation in Clinically Important Genes

“…ClinVar was recently found to be missing a large number of hearing impairment variants that primarily affect individuals of African ancestry 52 , likely indicative of a broader pattern. For variant predictors, this bias will lead to greater reliance on European ancestry variants and European genetic context, producing less accurate classification of IEM and PGX variants in other ancestries (e.g., African ancestry), which would only compound existing injustice in healthcare access for underrepresented populations 53,54 . Disparity in ancestry representation is especially stark in data sources for Genome Wide Association Studies (GWAS), where European ancestry disproportionately represents 81% of the data set population 48 .…”