Portal Flow Pulsatility as a Risk Factor for Acute Kidney Injury After Cardiac Surgery

N/ACompletedNCT02831907

Montreal Heart Institute146 enrolled

Overview

The purpose of this study is to evaluate the possible association between portal vein flow pulsatility and acute kidney injury after cardiac surgery. Participants will undergo assessment of portal vein flow and intra-renal blood flow using bedside Doppler ultrasound before surgery and daily for three days after cardiac surgery.

Acute kidney injury is a frequent complication after cardiac surgery. Venous congestion from right ventricular dysfunction and fluid overload can impair kidney perfusion resulting in the cardio-renal syndrome. An increase in the variation of blood flow velocity in the portal vein during the cardiac cycle called portal pulsatility is a sign of congestive heart failure. Portal pulsatility occurs when increased central venous pressure results liver venous congestion. The presence of abnormal portal pulsatility could be used as a marker of venous congestions in other organs such as the kidneys. Discontinuous intra-renal vein flow is a risk factor for death or re-hospitalization in heart failure patients and could be seen in patients with portal pulsatility.

Study Type

OBSERVATIONAL

Enrollment

146

Conditions

C.Surgical Procedure; Cardiac Acute Kidney Injury Postoperative Complications Right-Sided Heart Failure Cardio-Renal Syndrome

Interventions

Cardiac surgeryPROCEDURE

All cardiac surgery procedures with the use of cardiopulmonary bypass

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 18 years and older. * Undergoing cardiac surgery with the use of cardiopulmonary bypass * Able to provide consent. Exclusion Criteria: * Chronic renal replacement therapy before the procedure. * Chronic kidney disease stage 5 defined as a estimated glomerular filtration rate by the MDRD equation (eGFR-MDRD) of 15 mL/min/1,73m2 or less. * Critical pre-operative state defined as aborted sudden death, preoperative cardiac massage, preoperative ventilation before anaesthetic room, preoperative inotropes or intra-aortic counterpulsation balloon. * Patients previously diagnosed with a condition interfering with Doppler evaluation of the portal system: Portal vein thrombosis, Cirrhosis. * Patients with documented AKI before surgery. * Confirmed or suspected pregnancy. * Kidney transplant recipients.

Locations (1)

Montreal Heart Institute

Montreal, Quebec, Canada

Outcomes

Primary Outcomes

Acute kidney injury defined by an increase in serum creatinine of ≥150% of baseline or an elevation of 0.3 mg/dL or more within a contiguous period of 48 hours. (KDIGO criteria)

The definition of acute kidney injury is based on the KDIGO guidelines

Time frame: 7 days after surgery

Secondary Outcomes

Mortality

Time frame: 30 days after surgery

Duration of intensive care stay

Time frame: 30 days after surgery

Delirium defined as an Intensive Care Delirium Screening Checklist score of 4 or more.

Intensive Care Delirium Screening Checklist is a validated tool for the screening of delirium in the intensive care unit.

Time frame: 7 days after surgery

Composite endpoint of persistent organ dysfunction (POD) plus death at day 3 and 7

Persistent organ dysfunction (POD) plus death is a validated outcome measure in cardiac surgery patients. It is defined as one of the following: mechanical ventilation without breaks for a period of more than 48 hours or vasopressor therapy (ongoing need for vasopressor agents such as norepinephrine, epinephrine, vasopressin, dopamine 45 μg/ kg/min, or phenylephrine 450 μg/min for more than 2 hours in a given day); or mechanical circulatory support (ongoing need for mechanical devices such as extracorporeal membrane oxygenation or intra-aortic counterpulsation balloon pump) or continuous renal replacement therapy or new intermittent hemodialysis; or death.

Time frame: 3 days and 7 days after surgery

Severe acute kidney injury (KDIGO stage 2 or more) defined by an increase in serum creatinine of ≥200% of baseline.

The definition of acute kidney injury is based on the KDIGO guidelines

Data from ClinicalTrials.gov

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