Postoperative Acute Kidney Injury Clinical Trial
Official title:
Correlation Between Monitoring Renal Hemodynamics by Esophageal Ultrasound and Acute Kidney Injury After Heart Surgery.
Acute kidney injury (AKI) is a common complication of cardiac surgery, which seriously
affects the postoperative complication rate and mortality of patients.Acute kidney injury
occurs in 5-30% of patients after cardiac surgery, but severe acute kidney injury requiring
dialysis is relatively rare.At present, the diagnosis of AKI is based on serum creatinine
(Scr) or urine volume. However, the changes of serum creatinine value have hysteresis, and
the increase of serum creatinine level lags behind kidney injury for 48 ~ 72 h.Some drugs can
also affect creatinine levels.Urine volume is also affected by many factors.Due to the lack
of sensitivity and specificity of SCr, it is very important to find and adopt new early AKI
markers.Kidney is an important metabolic organ of human body. Different from cerebrovascular
system, kidney lacks automatic regulation ability and is easily affected by perfusion
flow.Previous experiments have shown that placing a multi-plane esophageal probe into the
human stomach through the esophagus can monitor the changes of left renal blood flow before,
during and after cardiovascular surgery extracorporeal circulation, and has good
repeatability, which may become an effective means to monitor renal blood flow during
cardiovascular surgery.
In conclusion, this study intends to use esophageal ultrasound as a means to monitor renal
blood flow, observe the changes of intraoperative renal hemodynamic indexes, and use KDIGO (
Kidney Disease:Improving Global Outcomes)as the standard of renal injury to explore the
correlation between intraoperative hemodynamic changes and postoperative AKI, providing a new
perspective for the pathophysiological study of AKI after cardiopulmonary bypass.
Status | Not yet recruiting |
Enrollment | 60 |
Est. completion date | September 30, 2019 |
Est. primary completion date | August 30, 2019 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 70 Years |
Eligibility |
Inclusion Criteria: - Aged between 18 and 70; - Elective cardiopulmonary bypass for patients undergoing cardiac surgery Exclusion Criteria: - Acute myocardial infarction surgery within 7 days - Emergency surgery - Known renal artery stenosis, renal malformation;Renal failure - Congenital esophageal malformation - Patients with previous history of stomach and esophagus should avoid intraoperative esophageal ultrasound examination - Existing acute kidney injury, kidney transplantation, chronic kidney disease and glomerular filtration rate less than 30 ml/min, - Pregnancy |
Country | Name | City | State |
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n/a |
Lead Sponsor | Collaborator |
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Xuzhou Medical University |
Bellos I, Pergialiotis V, Kontzoglou K. Renal resistive index as predictor of acute kidney injury after major surgery: A systematic review and meta-analysis. J Crit Care. 2018 Nov 15;50:36-43. doi: 10.1016/j.jcrc.2018.11.001. [Epub ahead of print] Review. — View Citation
Regolisti G, Maggiore U, Cademartiri C, Belli L, Gherli T, Cabassi A, Morabito S, Castellano G, Gesualdo L, Fiaccadori E. Renal resistive index by transesophageal and transparietal echo-doppler imaging for the prediction of acute kidney injury in patients — View Citation
Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment. Nat Rev Nephrol. 2017 Nov;13(11):697-711. doi: 10.1038/nrneph.2017.119. Epub 2017 Sep 4. Review. — View Citation
Weisse AB. Cardiac surgery: a century of progress. Tex Heart Inst J. 2011;38(5):486-90. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | AUC(RI) | ROC curve(receiver operating characteristic curve)will be drawn according to the incidence of renal resistance index (RI) monitored by TEE and the incidence of postoperative AKI in patients, and AUC value(Area Under Curve) will be statistically analyzed. | RI monitored 30 minutes after cardiopulmonary bypass termination | |
Primary | AUC(PI) | ROC curve will be drawn according to the incidence of renal pulsatility index (PI) monitored by TEE and the incidence of postoperative AKI in patients, and AUC value will be statistically analyzed. | PI monitored 30 minutes after cardiopulmonary bypass termination | |
Secondary | Changes in biomarkers | Analysis of insulin-like growth factor-binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases-2 (TIMP-2) concentrations (both induction factors for G1 cell cycle arrest are associated with acute kidney injury and are predicted as biomarkers). | Before surgery and at 4 hours, 12 hours, and 24 hours after surgery | |
Secondary | Length of ICU stay | All patients are routinely transferred to ICU after surgery | an average of 2 days | |
Secondary | Length of hospital stay | All patients are routinely transferred to ICU after surgery | an average of 10 days | |
Secondary | Use of renal replacement therapy | The use of postoperative renal replacement therapy depends on the diagnosis and treatment of ICU staff. | Until 3 months after discharge | |
Secondary | Survival rate | Record the survival rate after hospital discharged. | At 1, 7 and 30 days after discharge |
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