Update on clinical trials for the prevention of acute kidney injury in patients undergoing cardiac surgery

Alsabbagh, Mourad M.; Asmar, Abdo; Ejaz, Noel I.; Aiyer, Ravi; Kambhampati, Ganesh; Ejaz, A. Ahsan

doi:10.1016/j.amjsurg.2012.08.007

Cited by 33 publications

(29 citation statements)

References 89 publications

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“…The need for IABP usually represents the hemodynamic instability. In addition, IABP use may result in ischemic complications because of a decrease in blood flow below the descending aorta . Thus, clinical studies have demonstrated the association between the IABP use and post‐operative AKI as shown in our study.…”

Section: Discussionsupporting

confidence: 75%

Incidence and risk factors of acute kidney injury following transcatheter aortic valve replacement

et al. 2016

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Section: Discussionsupporting

confidence: 75%

Incidence and risk factors of acute kidney injury following transcatheter aortic valve replacement

et al. 2016

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“…Hence, we conducted protocol-based management in CKD patients who underwent OPCAB based on well-established evidence and current guidelines [14,20]. Our protocol-based perioperative care approach for preventing renal injury requiring RRT can be divided into 3 phases: the preoperative phase, in which radiocontrast exposure is minimized while carrying out risk evaluation; the intraoperative phase, in which optimal hemodynamic status and oxygen carrying capacity are maintained; and the postoperative phase, in which dehydration is prevented, omitting nephrotoxic drugs, and sufficient kidney blood flow is maintained to prevent pre-renal and renal AKI.…”

Section: Discussionmentioning

confidence: 99%

Results of Protocol-based Perioperative Management in Off-Pump Coronary Artery Bypass Grafting for Patients with Non-dialysis-dependent Chronic Kidney Disease

Kim

Sim

Yoo

et al. 2016

Korean J Thorac Cardiovasc Surg

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BackgroundRecent studies have demonstrated the benefits of off-pump coronary bypass grafting over the on-pump technique in patients with chronic kidney disease (CKD). To further reduce the risk of acute kidney injury and the need for renal replacement therapy, even in patients undergoing off-pump coronary artery bypass grafting, we adopted protocol-based perioperative management for patients with CKD.MethodsFrom December 2012 to March 2015, 265 patients underwent isolated off-pump coronary artery bypass grafting. To analyze renal function in a stable condition, we excluded 12 dialysis-dependent end stage renal failure and 10 emergency or urgent cases. Among the remaining 243 patients, 208 patients had normal kidney function (normal group), and 35 patients had CKD (CKD group). Minimizing contrast exposure, ensuring adequate hydration, using strict drug dosage adjustment, and optimizing hemodynamic status were key elements of the protocol for the CKD group.ResultsThe risk of acute kidney injury was about ×3 higher in the CKD group than in the normal group (p=0.01). Estimated glomerular filtration rates and serum creatinine levels deteriorated until the third postoperative day in the CKD group. However, by adopting protocol-based perioperative management, this transient renal dysfunction recovered to preoperative levels by the fifth postoperative day without requiring renal replacement therapy in all cases.ConclusionOff-pump coronary bypass surgery combined with this protocol-based perioperative management strategy in patients with non-dialysis-dependent CKD could mostly be performed without renal replacement therapy.

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“…The lack of effect of ApAP on postoperative kidney function is in keeping with the failure of other anti-oxidants such as N-acetylcysteine, vitamin C and vitamin E to protect the kidney after cardiac surgery. (28)…”

Section: Discussionmentioning

confidence: 99%

Acetaminophen Attenuates Lipid Peroxidation in Children Undergoing Cardiopulmonary Bypass

Simpson

Zaccagni

Bichell

et al. 2014

Pediatric Critical Care Medicine

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Objective Hemolysis, occurring during cardiopulmonary bypass (CPB), is associated with lipid peroxidation and postoperative acute kidney injury (AKI). Acetaminophen (ApAP) inhibits lipid peroxidation catalyzed by hemeproteins and in an animal model attenuated rhabdomyolysis-induced AKI. This pilot study tests the hypothesis that ApAP attenuates lipid peroxidation in children undergoing CPB. Design Single center prospective randomized double blinded study. Setting University-affiliated pediatric hospital. Patients Thirty children undergoing elective surgical correction of a congenital heart defect. Interventions Patients were randomized to ApAP (OFIRMEV® (acetaminophen) injection, Cadence Pharmaceuticals, San Diego, CA) or placebo every 6 hours for 4 doses starting before the onset of CPB. Measurement and Main Results Markers of hemolysis, lipid peroxidation (isofurans and F2-isoprostanes) and AKI were measured throughout the perioperative period. CPB was associated with a significant increase in free hemoglobin (from a pre-bypass level of 9.8±6.2 mg/dl to a peak of 201.5±42.6 mg/dl post-bypass). Plasma and urine isofuran and F2-isoprostane concentrations increased significantly during surgery. The magnitude of increase in plasma isofurans was greater than the magnitude in increase in plasma F2-isoprostanes. ApAP attenuated the increase in plasma isofurans compared to placebo (P=0.02 for effect of study drug). There was no significant effect of ApAP on plasma F2-isoprostanes or urinary makers of lipid peroxidation. ApAP did not affect postoperative creatinine, urinary neutrophil gelatinase-associated lipocalin or prevalence of AKI. Conclusion CPB in children is associated with hemolysis and lipid peroxidation. ApAP attenuated the increase in plasma isofuran concentrations. Future studies are needed to establish whether other therapies that attenuate or prevent the effects of free hemoglobin result in more effective inhibition of lipid peroxidation in patients undergoing CPB.

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Update on clinical trials for the prevention of acute kidney injury in patients undergoing cardiac surgery

Cited by 33 publications

References 89 publications

Incidence and risk factors of acute kidney injury following transcatheter aortic valve replacement

Incidence and risk factors of acute kidney injury following transcatheter aortic valve replacement

Results of Protocol-based Perioperative Management in Off-Pump Coronary Artery Bypass Grafting for Patients with Non-dialysis-dependent Chronic Kidney Disease

Acetaminophen Attenuates Lipid Peroxidation in Children Undergoing Cardiopulmonary Bypass

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