During open cardiac surgery, cardiopulmonary bypass (CPB) is used to temporarily replace the function of the heart and lungs. Renal ischemia resulting in acute kidney injury is common after cardiac surgery. The renal oxygenation is impaired during CPB, but the oxygenation may be improved by increasing the CPB blood flow. In this randomized study, two CPB flow rates will be compared regarding renal outcome (biomarkers and renal oxygenation/renal blood flow), as well as markers of inflammation and hemolysis. Additionally, urine oxygen tension will be measured during CPB and the early intensive care phase and compared to renal oxygenation. Regional oxygen saturation assessed with near infrared spectroscopy from the brain and kidneys will be monitored during and after surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
100
Target CPB flow 2.9 L/min/m2 throughout the CPB period
Lukas Lannemyr
Gothenburg, Västra Götaland County, Sweden
Biomarker u-NAG
Tubulus injury biomarker N-acetyl-ß-d-glucoseaminidase (NAG) will be analyzed in urine with a spectrophotometric method and corrected for urine creatinine.
Time frame: 24 hours
Biomarkers Nephrocheck
Renal biomarker assay Nephrocheck (IGFBP-7 x TIMP-2) will be analyzed in urine
Time frame: 24 hours
Renal oxygen delivery and blood flow
Renal oxygen delivery during and after cardiopulmonary bypass (CPB)
Time frame: 6 hours
Serum creatinine and acute kidney injury (AKI)
Changes in serum creatinine
Time frame: 48 hours
Inflammation IL-1
Differences in inflammatory marker IL-1
Time frame: 24 hours
Inflammation IL-6
Differences in inflammatory marker IL-6
Time frame: 24 hours
Inflammation IL-8
Differences in inflammatory marker IL-8
Time frame: 24 hours
Inflammation IL-10
Differences in inflammatory markers IL-1, IL-6, IL-8, IL-10 and TNFa
Time frame: 24 hours
Inflammation TNFa
Differences in inflammatory marker TNFa
Time frame: 24 hours
Complement activation
Differences in complement activation
Time frame: 24 hours
Hemolysis
Differences in markers of hemolysis (free plasma Hb, LD, haptoglobin)
Time frame: 24 hours
Erythropoetin
Differences in serum-erythropoietin
Time frame: 24 hours
Neuroinflammation Tau
Changes in Tau
Time frame: 4 days
Neuroinflammation NF
Changes Neurofilament
Time frame: 4 days
Kidney function
Measured glomerular filtration rate (iohexol clearance) on postoperative day 1
Time frame: 24 hours
Renal function
Measured glomerular filtration rate by iohexole clearance on the first postoperative day
Time frame: 24 hours
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