Prevention of Post-Cardiac Surgery Acute Kidney Injury by Proton Pump Inhibitor

Last updated: April 29, 2025
Sponsor: The University of Texas Health Science Center, Houston
Overall Status: Completed

Phase

2

Condition

Kidney Disease

Renal Failure

Kidney Failure

Treatment

Famotidine

Pantoprazole

Clinical Study ID

NCT06154226
HSC-MS-22-0502
  • Ages 18-90
  • All Genders

Study Summary

The purpose of this study is to determine whether perioperative intravenous administration of pantoprazole will improve kidney function parameters following cardiac surgery with cardiopulmonary bypass compared to famotidine and to determine whether perioperative intravenous administration of pantoprazole will decrease the incidence of postoperative Acte Kidney Injury (AKI) and major adverse kidney events (MAKE).

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Scheduled for elective cardiac surgery with cardio pulmonary bypass (CPB) with amoderate to high risk of developing AKI (Cleveland risk score equal or higher than

Exclusion

Exclusion Criteria:

  • Preoperative eGFR<30 ml/min per 1.73 m2

  • Dialysis dependence

  • Emergency surgery

  • Interstitial nephritis

  • Pregnancy

  • Nursing Patients

  • Proton pump inhibitors (PPIs) hypersensitivity

  • Liver disease

  • Vitamin B12 deficiency

Study Design

Total Participants: 100
Treatment Group(s): 2
Primary Treatment: Famotidine
Phase: 2
Study Start date:
January 10, 2024
Estimated Completion Date:
October 10, 2024

Study Description

Each year more than 500,000 cardiac surgeries are performed in the United States of America (USA) alone. Acute kidney injury ( AK) I is a common complication following cardiac surgery and is associated with poor patient outcomes and increased healthcare costs. Therefore, there is an urgent need to identify medical interventions and treatments that prevent AKI or mitigate its severity when it occurs after cardiac surgery.

One of the main causes of AKI following cardiac surgery involves renal hypoperfusion/ischemia and reperfusion injury. Hypoxia-inducible factors (HIFs) are key transcription factors responsible for tissue adaptation to low oxygen, which orchestrate the expression of a wide variety of genes including a set of micro-ribonucleic acid (microRNAs). MicroRNAs are endogenous single-stranded noncoding miRNAs of nucleotides that participate in physiological and pathological functions via regulating post-transcription of target genes. During ischemic injury, hypoxia upregulates endothelial MicroRNAs that has the potential in renal protection through vascular integrity and regeneration. Additionally, microRNAs exert protective effects via decreasing apoptosis and promoting tubular cell proliferation during ischemic AKI.

Moreover, decreased serum levels of MicroRNAs are highly correlated with AKI severity in the intensive care unit (ICU) patients. Our preliminary study identified ATP4A as the downstream target gene of MicroRNAs in the kidney. Adenosine triphosphate (ATP)4A (catalytic α subunit of H+/K+ ATPase) is located in intercalated cells in the distal tubules and cortical collecting ducts, which regulates urine acidification through secretion of hydrogen and reabsorption of potassium from urine. Proton pump inhibitors (PPIs) block the ATP hydrolysis of the H+/K+ ATPase via binding its active site of ATP4A and further enhance this endogenous kidney protection pathway. Despite robust animal model data, randomized controlled trial aiming to test the effectiveness of PPI in post-cardiac surgery AKI prevention is lacking. If proven to be effective, our studies could be easily implemented in clinical practice and serve as an effective treatment for perioperative AKI.

Connect with a study center

  • The University of Texas Health Science Center at Houston

    Houston, Texas 77030
    United States

    Site Not Available

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