Nitric oxide delivery during cardiopulmonary bypass reduces acute kidney injury: A randomized trial

医学 体外循环 四分位间距 急性肾损伤 麻醉 随机对照试验 置信区间 心脏外科 泌尿系统 外科 内科学
作者
N. O. Kamenshchikov,Yana Anfinogenova,Б. Н. Козлов,Yulia S. Svirko,S. Pekarskiy,В. В. Евтушенко,Vladimir A. Lugovsky,В. М. Шипулин,В. В. Ломиворотов,Yuriy K. Podoksenov
出处
期刊:The Journal of Thoracic and Cardiovascular Surgery [Elsevier BV]
卷期号:163 (4): 1393-1403.e9 被引量:41
标识
DOI:10.1016/j.jtcvs.2020.03.182
摘要

Acute kidney injury (AKI) is a serious complication of cardiac surgery with cardiopulmonary bypass (CPB). The aim of this study was to evaluate the effects of nitric oxide (NO) supplementation to the CPB circuit on the development of cardiac surgery-associated AKI.This prospective randomized controlled study included 96 patients with moderate risk of renal complications who underwent elective cardiac surgery with CPB. The study protocol was registered at ClinicalTrials.gov (identifier NCT03527381). Patients were randomly allocated to either NO supplementation to the CPB bypass circuit (NO treatment group; n = 48) or usual care (control group; n = 48). In the NO treatment group, 40-ppm NO was administered during the entire CPB period. The primary outcome was the incidence of AKI.NO treatment was associated with a significant decrease in AKI incidence (10 cases [20.8%] vs 20 cases [41.6%] in the control group; relative risk, 0.5; 95% confidence interval, 0.26-0.95; P = .023) and a higher median urine output during CPB (2.6 mL/kg/h [interquartile range (IQR), 2.1-5.08 mL/kg/h] vs 1.7 mL/kg/h [IQR, 0.80-2.50 mL/kg/h]; P = .0002). The median urinary neutrophil gelatinase-associated lipocalin level at 4 hours after surgery was significantly lower in the NO treatment group (1.12 ng/mL [IQR, 0.75-5.8 ng/mL] vs 4.62 ng/mL [IQR, 2.02-34.55 ng/mL]; P = .005). In the NO treatment group, concentrations of NO metabolites were significantly increased at 5 minutes postclamping, at 5 minutes after declamping, and at the end of the operation. Concentrations of proinflammatory and anti-inflammatory mediators and free plasma hemoglobin did not differ significantly between the 2 groups.NO administration in patients at moderate risk of renal complications undergoing elective cardiac surgery with CPB was associated with a lower incidence of AKI.
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