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Perfusion. 2014 Nov;29(6):496-504. doi: 10.1177/0267659114527331. Epub 2014 Mar 11.

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

Author information

  • 1Department of Anesthesia and Surgical Intensive Care, LUNAM Université, Université d'Angers, Angers, Larrey, France.
  • 2Department of Cardiac Surgery, LUNAM Université, Université d'Angers, Angers, Larrey, France.
  • 3Department of Anesthesia and Surgical Intensive Care, LUNAM Université, Université d'Angers, Angers, Larrey, France lbeydon.angers@invivo.edu.

Abstract

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 1.73 m(2) 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<0.001). The rate of AKI did not differ by group (17% vs. 17%; p=1), whatever the criteria used for AKI. The length of stay in hospital (9.5 days [7.9-11.2] vs. 8.2 [7.1-9.4]) and the rate of death at day 28 (2.1% vs. 3.4%) and at six months (3.4% vs. 4.8%) did not differ between the groups.

CONCLUSION:

Maintaining a high level of MAP (on average) during normothermic CPB does not reduce the risk of postoperative AKI. It does not alter the length of hospital stay or the mortality rate.

KEYWORDS:

acute kidney injury; arterial pressure; cardiac surgery; cardiopulmonary bypass; primary prevention

PMID:
24619062
DOI:
10.1177/0267659114527331
[PubMed - indexed for MEDLINE]
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