Acute Kidney Injury After Cardiac Surgery

  • STATUS
    Recruiting
  • End date
    Oct 26, 2021
  • participants needed
    850
  • sponsor
    Rennes University Hospital
Updated on 26 January 2021
early diagnosis
insulin
nephropathy
acute renal failure
renal injury
heart surgery
oliguria
cardiopulmonary bypass
kidney injury

Summary

Acute kidney injury (AKI) is common after cardiac surgery. The diagnosis is based on the criteria defined by the Kidney Disease Improving Global Outcomes (KDIGO) classification: oliguria and elevation of serum creatinine. However, oliguria is not specific of AKI and elevation of serum creatinine is too late. Therefore, new methods have been developed to earlier assess the risk of AKI.

Among those methods, it has been shown that the increase of urinary dosage, in the hours following the surgery, of two proteins (Tissue Inhibitor of Metallo-Protease 2 (TIMP2) and Insulin Growth Factor Binding Protein 7 (IGFBP7)) is associated with an increased risk of occurrence of AKI in patients hospitalized in intensive care unit. The Nephrocheck test combines the urinary dosage of those two proteins TIMP2 and IGFBP7.

Insofar as post-surgery low cardiac output is one curable cause of AKI, the early detection of early kidney risk allows corrective measures to stabilize hemodynamic state and thus to reduce the risk of AKI.

Description

The usual diagnostic markers of AKI are defaulted. Indeed, oliguria tends to overstate the impact of AKI, up to 40-50% of patients. Postoperative increased serum creatinine is a late marker for the AKI. Furthermore, perioperative hemodilution and serum creatinine kinetic delay the postoperative peak of serum creatinine from 48 to 72 h.

Nephrocheck test combines the urinary dosage of 2 proteins (TIMP2 and IGFBP7). These 2 proteins are excreted by the tubular cell in case of suffering whatever the origin, for example tissue hypoxia by low renal blood flow or a systemic inflammatory response. In a medical ICU, the test performed within 4 to 12 hours after kidney aggression can predict the onset of persistent AKI beyond 4 weeks.

Until randomization, all patients are treated according to the standard of care for the center. This includes a blood test upon arrival in the intensive care unit and continuous monitoring of vital parameters.

Details
Condition Renal Failure, Thoracic Surgery, Acute renal failure, heart surgery, Kidney Failure (Pediatric), Cardiac Surgery, Kidney Failure, acute kidney injury, cardiac operation, acute kidney injuries
Treatment Standard clinical routine, Nephrocheck test
Clinical Study IdentifierNCT03396770
SponsorRennes University Hospital
Last Modified on26 January 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

On-pump cardiac surgery
Informed and written consent of the patient or inclusion according to the emergency procedure
Affiliated patient or beneficiary of a social protection

Exclusion Criteria

Left and / or right ventricular assist device
Heart transplant
Chronic kidney disease with renal replacement therapy before surgery
Hemorrhagic shock requiring surgical hemostasis at the time of randomization
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