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

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Abstract
Objective: To determine whether a goal-directed perfusion (GDP) strategy aimed at maintaining oxygen delivery (DO2) at >= 280 mL.min(-1).m(-2) reduces the incidence of acute kidney injury (AKI). Methods: This multicenter randomized trial enrolled a total of 350 patients undergoing cardiac surgery in 9 institutions. Patients were randomized to receive either GDP or conventional perfusion. A total of 326 patients completed the study and were analyzed. Patients in the treatment arm were treated with a GDP strategy during cardiopulmonary bypass (CPB) aimed to maintain DO2 at >= 280 mL.min(-1).m(-2). The perfusion strategy for patients in the control arm was factored on body surface area and temperature. The primary endpoint was the rate of AKI. Secondary endpoints were intensive care unit length of stay, major morbidity, red blood cell transfusions, and operative mortality. Results: Acute Kidney Injury Network (AKIN) stage 1 was reduced in patients treated with GDP (relative risk [RR], 0.45; 95% confidence interval [CI], 0.25-0.83; P = .01). AKIN stage 2-3 did not differ between the 2 study arms (RR, 1.66; 95% CI, 0.46-6.0; P = .528). There were no significant differences in secondary outcomes. In a prespecified analysis of patients with a CPB time between 1 and 3 hours, the differences in favor of the treatment arm were more pronounced, with an RR for AKI of 0.49 (95% CI, 0.27-0.89; P = .017). Conclusions: 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).
Keywords
ACUTE-RENAL-FAILURE, CARDIAC-SURGERY, CARDIOPULMONARY BYPASS, OXYGEN, DELIVERY, RISK, HEMATOCRIT, OPERATIONS, MORTALITY, IMPACT, ADULT, cardiac surgery, cardiopulmonary bypass, oxygen delivery, acute kidney, injury

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Chicago
Ranucci, Marco, Ian Johnson, Timothy Willcox, Robert A Baker, Christa Boer, Andreas Baumann, George A Justison, et al. 2018. “Goal-directed Perfusion to Reduce Acute Kidney Injury : a Randomized Trial.” Journal of Thoracic and Cardiovascular Surgery 156 (5): 1918–1927.
APA
Ranucci, M., Johnson, I., Willcox, T., Baker, R. A., Boer, C., Baumann, A., Justison, G. A., et al. (2018). Goal-directed perfusion to reduce acute kidney injury : a randomized trial. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 156(5), 1918–1927.
Vancouver
1.
Ranucci M, Johnson I, Willcox T, Baker RA, Boer C, Baumann A, et al. Goal-directed perfusion to reduce acute kidney injury : a randomized trial. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY. 2018;156(5):1918–27.
MLA
Ranucci, Marco, Ian Johnson, Timothy Willcox, et al. “Goal-directed Perfusion to Reduce Acute Kidney Injury : a Randomized Trial.” JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 156.5 (2018): 1918–1927. Print.
@article{8581266,
  abstract     = {Objective: To determine whether a goal-directed perfusion (GDP) strategy aimed at maintaining oxygen delivery (DO2) at {\textrangle}= 280 mL.min(-1).m(-2) reduces the incidence of acute kidney injury (AKI). 
Methods: This multicenter randomized trial enrolled a total of 350 patients undergoing cardiac surgery in 9 institutions. Patients were randomized to receive either GDP or conventional perfusion. A total of 326 patients completed the study and were analyzed. Patients in the treatment arm were treated with a GDP strategy during cardiopulmonary bypass (CPB) aimed to maintain DO2 at {\textrangle}= 280 mL.min(-1).m(-2). The perfusion strategy for patients in the control arm was factored on body surface area and temperature. The primary endpoint was the rate of AKI. Secondary endpoints were intensive care unit length of stay, major morbidity, red blood cell transfusions, and operative mortality. 
Results: Acute Kidney Injury Network (AKIN) stage 1 was reduced in patients treated with GDP (relative risk [RR], 0.45; 95\% confidence interval [CI], 0.25-0.83; P = .01). AKIN stage 2-3 did not differ between the 2 study arms (RR, 1.66; 95\% CI, 0.46-6.0; P = .528). There were no significant differences in secondary outcomes. In a prespecified analysis of patients with a CPB time between 1 and 3 hours, the differences in favor of the treatment arm were more pronounced, with an RR for AKI of 0.49 (95\% CI, 0.27-0.89; P = .017). 
Conclusions: 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).},
  author       = {Ranucci, Marco and Johnson, Ian and Willcox, Timothy and Baker, Robert A and Boer, Christa and Baumann, Andreas and Justison, George A and De Somer, Filip and Exton, Paul and Agarwal, Seema and Parke, Rachael and Newland, Richard F and Haumann, Renard G and Buchwald, Dirk and Weitzel, Nathaen and Venkateswaran, Rajamiyer and Ambrogi, Federico and Pistuddi, Valeria},
  issn         = {0022-5223},
  journal      = {JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY},
  language     = {eng},
  number       = {5},
  pages        = {1918--1927},
  title        = {Goal-directed perfusion to reduce acute kidney injury : a randomized trial},
  url          = {http://dx.doi.org/10.1016/j.jtcvs.2018.04.045},
  volume       = {156},
  year         = {2018},
}

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