Nephrology intervention to avoid acute kidney injury in patients awaiting cardiac surgery: randomized clinical trial
IntroductionCardiac surgery-associated acute kidney injury (CSA-AKI) is a well-known complication that increases morbidity and mortality rates. The objective of this study was to reduce CSA-AKI through nephrologist intervention in patients awaiting cardiac surgery.MethodsWe performed a single center...
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Frontiers Media S.A.
2024-11-01
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| Series: | Frontiers in Nephrology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneph.2024.1470926/full |
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| author | Sergi Codina Sergi Codina Laia Oliveras Laia Oliveras Eva Ferreiro Aroa Rovira Ana Coloma Nuria Lloberas Edoardo Melilli Miguel Hueso Miguel Hueso Fabrizio Sbraga Enric Boza José M. Vazquez José L. Pérez-Fernández Joan Sabater Josep M. Cruzado Josep M. Cruzado Nuria Montero Nuria Montero |
| author_facet | Sergi Codina Sergi Codina Laia Oliveras Laia Oliveras Eva Ferreiro Aroa Rovira Ana Coloma Nuria Lloberas Edoardo Melilli Miguel Hueso Miguel Hueso Fabrizio Sbraga Enric Boza José M. Vazquez José L. Pérez-Fernández Joan Sabater Josep M. Cruzado Josep M. Cruzado Nuria Montero Nuria Montero |
| author_sort | Sergi Codina |
| collection | DOAJ |
| description | IntroductionCardiac surgery-associated acute kidney injury (CSA-AKI) is a well-known complication that increases morbidity and mortality rates. The objective of this study was to reduce CSA-AKI through nephrologist intervention in patients awaiting cardiac surgery.MethodsWe performed a single center, open-label, randomized clinical trial including 380 patients who underwent scheduled cardiac surgery at the Hospital de Bellvitge between July 2015 and October 2019. A total of 184 patients were evaluated by the same Nephrologist one month before the surgery to minimize the risk factors for AKI. In addition to assessments at the outpatient clinic, we also collected clinical data during hospitalization and during the first year.ResultsDespite the intervention, no differences were observed between the groups in the incidence of CSA-AKI (intervention group 26.37% vs. standard of care 25.13%, p=0.874), mortality (3.91% vs. 3.59%, p=0.999), length of Intensive Care Unit (ICU) stay (10 days [7.00;15.0] for both groups, p=0.347), or renal function after one year of follow-up (estimated glomerular filtration rate (eGFR) by CKD-EPI: 74.5 ml/min (standard deviation 20.6) vs 76.7 (20.8) ml/min, respectively, p=0.364). A reduction in the need for blood transfusion was observed in the intervention group, although the difference was not statistically significant (37.22% vs. 45.03%, p =0.155).ConclusionIn this clinical trial, nephrologist intervention in the entire population on the cardiac surgery waiting list did not show a nephroprotective benefit.Clinical trial registrationClinicalTrials.gov, identifier (NCT02643745). |
| format | Article |
| id | doaj-art-0d1aa2c25b4647edb4398e004048bea2 |
| institution | Kabale University |
| issn | 2813-0626 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Nephrology |
| spelling | doaj-art-0d1aa2c25b4647edb4398e004048bea22024-11-13T06:21:28ZengFrontiers Media S.A.Frontiers in Nephrology2813-06262024-11-01410.3389/fneph.2024.14709261470926Nephrology intervention to avoid acute kidney injury in patients awaiting cardiac surgery: randomized clinical trialSergi Codina0Sergi Codina1Laia Oliveras2Laia Oliveras3Eva Ferreiro4Aroa Rovira5Ana Coloma6Nuria Lloberas7Edoardo Melilli8Miguel Hueso9Miguel Hueso10Fabrizio Sbraga11Enric Boza12José M. Vazquez13José L. Pérez-Fernández14Joan Sabater15Josep M. Cruzado16Josep M. Cruzado17Nuria Montero18Nuria Montero19Nephrology, Hospital de Bellvitge, Barcelona, SpainNephrology, Idibell, Barcelona, SpainNephrology, Hospital de Bellvitge, Barcelona, SpainNephrology, Idibell, Barcelona, SpainNephrology, Hospital de Bellvitge, Barcelona, SpainNephrology, Hospital de Vinaros, Vinaros, SpainNephrology, Hospital de Bellvitge, Barcelona, SpainNephrology, Idibell, Barcelona, SpainNephrology, Hospital de Bellvitge, Barcelona, SpainNephrology, Hospital de Bellvitge, Barcelona, SpainNephrology, Idibell, Barcelona, SpainCardiac Surgery, Hospital de Bellvitge, Barcelona, SpainAnesthesiology, Hospital de Bellvitge, Barcelona, SpainAnesthesiology Department, Hospital Universitari de Vall Hebrón, Barcelona, SpainIntensive Care Unit, Hospital de Bellvitge, Barcelona, SpainIntensive Care Unit, Hospital de Bellvitge, Barcelona, SpainNephrology, Hospital de Bellvitge, Barcelona, SpainNephrology, Idibell, Barcelona, SpainNephrology, Hospital de Bellvitge, Barcelona, SpainNephrology, Idibell, Barcelona, SpainIntroductionCardiac surgery-associated acute kidney injury (CSA-AKI) is a well-known complication that increases morbidity and mortality rates. The objective of this study was to reduce CSA-AKI through nephrologist intervention in patients awaiting cardiac surgery.MethodsWe performed a single center, open-label, randomized clinical trial including 380 patients who underwent scheduled cardiac surgery at the Hospital de Bellvitge between July 2015 and October 2019. A total of 184 patients were evaluated by the same Nephrologist one month before the surgery to minimize the risk factors for AKI. In addition to assessments at the outpatient clinic, we also collected clinical data during hospitalization and during the first year.ResultsDespite the intervention, no differences were observed between the groups in the incidence of CSA-AKI (intervention group 26.37% vs. standard of care 25.13%, p=0.874), mortality (3.91% vs. 3.59%, p=0.999), length of Intensive Care Unit (ICU) stay (10 days [7.00;15.0] for both groups, p=0.347), or renal function after one year of follow-up (estimated glomerular filtration rate (eGFR) by CKD-EPI: 74.5 ml/min (standard deviation 20.6) vs 76.7 (20.8) ml/min, respectively, p=0.364). A reduction in the need for blood transfusion was observed in the intervention group, although the difference was not statistically significant (37.22% vs. 45.03%, p =0.155).ConclusionIn this clinical trial, nephrologist intervention in the entire population on the cardiac surgery waiting list did not show a nephroprotective benefit.Clinical trial registrationClinicalTrials.gov, identifier (NCT02643745).https://www.frontiersin.org/articles/10.3389/fneph.2024.1470926/fullacute kidney injurycardiac surgerynephrology interventionclinical trialsintensive care |
| spellingShingle | Sergi Codina Sergi Codina Laia Oliveras Laia Oliveras Eva Ferreiro Aroa Rovira Ana Coloma Nuria Lloberas Edoardo Melilli Miguel Hueso Miguel Hueso Fabrizio Sbraga Enric Boza José M. Vazquez José L. Pérez-Fernández Joan Sabater Josep M. Cruzado Josep M. Cruzado Nuria Montero Nuria Montero Nephrology intervention to avoid acute kidney injury in patients awaiting cardiac surgery: randomized clinical trial Frontiers in Nephrology acute kidney injury cardiac surgery nephrology intervention clinical trials intensive care |
| title | Nephrology intervention to avoid acute kidney injury in patients awaiting cardiac surgery: randomized clinical trial |
| title_full | Nephrology intervention to avoid acute kidney injury in patients awaiting cardiac surgery: randomized clinical trial |
| title_fullStr | Nephrology intervention to avoid acute kidney injury in patients awaiting cardiac surgery: randomized clinical trial |
| title_full_unstemmed | Nephrology intervention to avoid acute kidney injury in patients awaiting cardiac surgery: randomized clinical trial |
| title_short | Nephrology intervention to avoid acute kidney injury in patients awaiting cardiac surgery: randomized clinical trial |
| title_sort | nephrology intervention to avoid acute kidney injury in patients awaiting cardiac surgery randomized clinical trial |
| topic | acute kidney injury cardiac surgery nephrology intervention clinical trials intensive care |
| url | https://www.frontiersin.org/articles/10.3389/fneph.2024.1470926/full |
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