LAIA OLIVERAS1, SERGI CODINA1, ANA COLOMA1, ROSA M PÉREZ-GARZÓN1, FABRIZIO SBRAGA1, ENRIC BOZA1, JOAN SABATER1, JOSÉ LUIS PÉREZ-FERNANDEZ1, JOSEP M CRUZADO1, NURIA MONTERO1
1Hospital Universitari De Bellvitge, L’Hospitalet de Llobregat, Spain
AIM AND BACKGROUND: Acute kidney injury (AKI) is a frequent complication after cardiac surgery. The objective is to evaluate whether a nephrological intervention before scheduled cardiac surgery can reduce the postoperative incidence of AKI.
METHODS: Single-center randomized controlled clinical trial of 371 participants undergoing elective cardiac surgery. Exclusion criteria were prior renal replacement therapy and emergent surgery. Nephrological intervention was performed at least 1 month before surgery and included preoperative study (analysis and bioimpedance), optimization of hydration status, elimination or dose minimization of nephrotoxic drugs, and correction of metabolic disorders. We have done a per-protocol analysis using the R-program. Primary outcome was AKI (KDIGO definition).
RESULTS: 176 patients were included in the Nephrology Intervention group and 195 in the control group, without differences in baseline characteristics (mean age 67.3±10.2 vs 66.3±11.4 years old; 66.4% vs 62.5% males; 25.6% vs 25.6 type 2 diabetes respectively). The most common surgery was heart-valve replacement (68.8 and 64.9%). An average of 2 nephrological interventions per patient were performed, with a 75.5% success rate before surgery. The number of patients with AKI was 96 (26.7% intervention group and 25.26% control group (p=0.843)): AKI stage 1: 33/176 vs 34/194, AKI stage 2: 7/176 vs 3/194, AKI stage 3: 7/176 vs 3/194. Mortality at 1 year was 14 patients (7 per group). Nephrological intervention was not associated with an increased risk of AKI. In multivariate analysis, age, baseline creatinine and time on extracorporeal-circulation were associated with AKI. There were no differences in renal function at 12months (89.3±29.1 vs 87.4±8μmol/mL).
CONCLUSIONS: No differences have been detected in incidence of AKI or mortality when a nephrological intervention is performed prior to elective cardiac surgery.
Biography:
Laia is a Nephrology fellow from the Hospital Universitari De Bellvitge, Barcelona. She is interested in glomerular diseases, kidney transplantation and clinical epidemiology.