Targeted Blood-pressure Management and Acute Kidney Injury After Coronary Artery Bypass Surgery

  • STATUS
    Recruiting
  • End date
    Jul 22, 2025
  • participants needed
    612
  • sponsor
    Peking University First Hospital
Updated on 14 February 2022
vasopressor
renal injury
heart surgery
coronary artery bypass graft
acute kidney injuries

Summary

Acute renal injury (AKI) is a common complication after cardiac surgery and is associated with worse outcomes. It is now realized that intraoperative hypotension is an important risk factor for the development of AKI. In a recent randomized controlled trial of patients undergoing major noncardiac surgery, intraoperative individualized blood-pressure management reduced the incidence of postoperative organ dysfunction. The investigators hypothesize that, for patients undergoing off-pump CABG, targeted blood-pressure management during surgery may also reduce the incidence of postoperative AKI.

Description

Acute renal injury (AKI) is a common complication after cardiac surgery. In patients undergoing noncardiac surgery, intraoperative hypotension may lead to hypoperfusion of important organs and result in organ injuries such as AKI, myocardial injury, and stroke. The development of organ injuries is associated with wose outcomes including higher 30-day or even 1-year mortality. In a recent randomized controlled trial, patients undergoing major noncardiac surgery received either individualized (systolic blood pressure [SBP] maintained within 10% of the reference level) or standard (SBP maintained above 80 mmHg or within 40% of the reference level) blood-pressure management strategy during surgery. The results showed that individualized blood-pressure management reduced the incidence of postoperative organ dysfunction. Intraoperative hypotension is very common during off-pump coronary artery bypass grafting (CABG) surgery. The investigators hypothesize that, for patients undergoing off-pump CABG, good blood-pressure management with norepinephrine may also reduce the incidence of postoperative AKI. The purpose of this study is to investigate the effect of targeted blood-pressure management during off-pump CABG surgery on the incidence of postoperative AKI.

Details
Condition Coronary Artery Bypass, Off-Pump, Intraoperative Hypotension, Acute Kidney Injury, Preventive Medicine, Intraoperative Care
Treatment Targeted blood-pressure management, Routine blood-pressure management
Clinical Study IdentifierNCT03629418
SponsorPeking University First Hospital
Last Modified on14 February 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Age 50 years
Scheduled to undergo off-pump CABG surgery

Exclusion Criteria

Refuse to participate
Untreated or uncontrolled severe hypertension (systolic blood pressure 180 mmHg or diastolic blood pressure 110 mmHg)
Chronic kidney disease with a glomerular filtration rate < 30 ml/min/1.73 m2 or end-stage renal disease requiring renal-replacement therapy
Inability to communicate during the preoperative period because of coma, profound dementia, language barrier, or end-stage disease
Requirement of vasopressors/inotropics to maintain blood pressure before surgery
Second or emergency surgery
Expected survival of less than 24 hours
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