SP242NEPHROLOGY INTERVENTION IN PATIENTS AWAITING CARDIAC SURGERY: A RANDOMISED CONTROLLED TRIAL

Abstract

INTRODUCTION AND AIMS: Acute kidney injury(AKI) is a frequent complication after cardiac surgery. Its incidence ranges from 19 to 44% depending on the study and which definition is used. There are some well-known risk factors associated with AKI, including baseline patient characteristics (age and comorbidities), need of perioperative blood transfusion or presence of previous chronic kidney disease. We wanted to evaluate if a nephrologist management and control of potential risk factors of renal disease can be used to prevent AKI, thereby minimizing the risk of need RRT, reducing costs and improving survival in these patients. It will be the first study focused on this intervention. The aim of this study is to assess if a nephrology intervention before cardiac surgery can reduce the postoperative incidence of AKI. METHOD(S): Unicentric prospective randomized controlled trial of 108 participants. The inclusion criteria was patients undergoing scheduled cardiac surgery of >18 years old. The exclusion criteria was current outpatient management by a nephrologist or CKD stage >3B (eGFR<45mL/min/1.73m2 estimated by CKD-EPI equation) or a requirement for renal replacement therapy before surgery. Clinical Research Ethics Committee of Bellvitge have approved the study before initiation. All patients have given written informed consent. We have done an intention-to-treat analysis, continuous variables have been compared between groups using Student's t test and categorical variables have been compared using X2. RESULT(S): Nephrology intervention before surgery, included a preoperative study done minimum 1 month before the surgery to optimise the patient' s overall condition by optimization of hydratation state, remove or minimize dose of drugs that potentially deteriorate kidney function and correct metabolic disorders. The characteristics of the patients is shown at Table 1. The number of patients with AKI KDIGO stage 1 was a total of 7 of which 3 were from the intervention arm and 4 were from the control arm (p=0.642), only one patients of the control group reached a stage 2 and none of them required renal replacement therapy. We found 0.019% of mortality (1 participant in the intervention group and one in control group). We have not been able to make a stratified analysis because the low incidence of AKI. Data at 1 year follow-up (n= 21) showed no indicidence of kidney disease (creatinine in intervention arm 90.6+/-41.5mumol/L and in control arm 72+/-20, p=0.1997) without differences in albuminuria. CONCLUSION(S): In summary, we did not find any difference in acute kidney injury and death when a nephrology intervention is done to cardiac surgery patients, probably it would be necessary to increase the sample size to make conclusions. The results at 1 year follow-up showed no kidney disease in these patients. We will maintain the recruitment until a larger sample size is obtained. (Table Presented).