Goal directed perfusion to reduce acute kidney injury: A randomized trial

Abstract Objective To determine whether a goal-directed perfusion (GDP) strategy, aimed at maintaining an oxygen delivery above 280 mL . min -1. m -2 reduces the incidence of acute kidney injury. Methods Multicenter randomized trial enrolling 350 patients undergoing cardiac surgery in nine institutions. Patients were randomized to receive either GDP or conventional perfusion. Three hundred and twenty-six patients completed the study and were analyzed. Patients in the treatment arm received a GDP strategy during cardiopulmonary bypass aimed to maintain an oxygen delivery ≥ 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 acute kidney injury rate. Secondary endpoints were intensive care unit length of stay; major morbidity; red blood cell transfusions; operative mortality. Results Acute Kidney Injury Network (AKIN) stage 1 was reduced in patients treated with GDP (relative risk 0.45, 95% CI 0.25-0.83, P=0.01). AKIN stage 2-3 did not differ between groups (relative risk 1.66, 95% CI 0.46-6.0, P=0.528). There were no significant differences in secondary outcomes. In a pre-specified analysis of patients with a cardiopulmonary bypass time between 1 and 3 hours, the differences in favor of the treatment arm were more pronounced, with a relative risk for acute kidney injury of 0.49 (95% CI 0.27-0.89, P=0.017). Conclusions A GDP strategy is effective in reducing AKIN stage 1 acute kidney injury, further studies are needed to define perfusion interventions that may reduce more severe levels of renal injury (AKIN stage 2 or 3).