Increasing mean arterial pressure during cardiac surgery does not reduce the rate of postoperative acute kidney injury

Introduction: We hypothesized that the optimization of renal haemodynamics by maintaining a high level of mean arterial blood pressure (MAP) during cardiopulmonary bypass (CPB) could reduce the rate of acute kidney injury (AKI) in high-risk patients. Methods: In this randomized, controlled study, we...

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Bibliographic Details
Published in:Perfusion 2014-11, Vol.29 (6), p.496-504
Main Authors: Azau, A, Markowicz, P, Corbeau, JJ, Cottineau, C, Moreau, X, Baufreton, C, Beydon, L
Format: Article
Language:English
Subjects:
Acute Kidney Injury - blood
Acute Kidney Injury - etiology
Acute Kidney Injury - mortality
Acute Kidney Injury - physiopathology
Aged
Aged, 80 and over
Arterial Pressure
Cardiopulmonary Bypass - adverse effects
Coronary Artery Disease - blood
Coronary Artery Disease - mortality
Coronary Artery Disease - physiopathology
Coronary Artery Disease - surgery
Diabetes Mellitus - blood
Diabetes Mellitus - mortality
Diabetes Mellitus - physiopathology
Diabetes Mellitus - surgery
Elective Surgical Procedures - adverse effects
Female
Humans
Length of Stay
Male
Postoperative Complications - blood
Postoperative Complications - pathology
Postoperative Complications - physiopathology
Prospective Studies
Survival Rate
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Summary:Introduction: We hypothesized that the optimization of renal haemodynamics by maintaining a high level of mean arterial blood pressure (MAP) during cardiopulmonary bypass (CPB) could reduce the rate of acute kidney injury (AKI) in high-risk patients. Methods: In this randomized, controlled study, we enrolled 300 patients scheduled for elective cardiac surgery under cardiopulmonary bypass. All had known risk factors of AKI: serum creatinine clearance between 30 and 60 ml/min for 1.73m2 or two factors among the following: age >60 years, diabetes mellitus, diffuse atherosclerosis. After a standardized fluid loading, the MAP was maintained between 75-85 mmHg during CPB with norepinephrine (High Pressure, n=147) versus 50-60 mmHg in the Control (n=145). AKI was defined by a 30% increased of serum creatinine (sCr). We further tested others definitions for AKI: RIFLE classification, 50% rise of sCr and the need for haemodialysis. Results: The pressure endpoints were achieved in both the High Pressure (79 ± 6 mmHg) and the Control groups (60 ± 6 mmHg; p
ISSN:0267-6591
1477-111X
DOI:10.1177/0267659114527331