American Journal of Kidney Diseases
Volume 50, Issue 2 , Pages 229-238, August 2007

A Randomized Trial of Pulsatile Perfusion Using an Intra-Aortic Balloon Pump Versus Nonpulsatile Perfusion on Short-Term Changes in Kidney Function During Cardiopulmonary Bypass During Myocardial Reperfusion

  • Francesco Onorati, MD

      Affiliations

    • Cardiac Surgery Unit, Magna Graecia University, Catanzaro, Italy
  • ,
  • Pierangela Presta, MD

      Affiliations

    • Nephrology Unit, Magna Graecia University, Catanzaro, Italy.
  • ,
  • Giorgio Fuiano, MD

      Affiliations

    • Nephrology Unit, Magna Graecia University, Catanzaro, Italy.
    • Corresponding Author InformationAddress correspondence to Giorgio Fuiano, MD, Professor of Nephrology, Cattedra di Nefrologia, Facoltà di Medicina, Campus Germaneto, Viale Europa 88100 Catanzaro, Italy.
  • ,
  • Pasquale Mastroroberto, MD

      Affiliations

    • Cardiac Surgery Unit, Magna Graecia University, Catanzaro, Italy
  • ,
  • Nicolino Comi, MD

      Affiliations

    • Nephrology Unit, Magna Graecia University, Catanzaro, Italy.
  • ,
  • Francesco Pezzo, MD

      Affiliations

    • Cardiac Surgery Unit, Magna Graecia University, Catanzaro, Italy
  • ,
  • Carmela Tozzo, MD

      Affiliations

    • Nephrology Unit, Magna Graecia University, Catanzaro, Italy.
  • ,
  • Attilio Renzulli, MD, PhD, FETCS

      Affiliations

    • Cardiac Surgery Unit, Magna Graecia University, Catanzaro, Italy

Received 29 December 2006; accepted 23 May 2007.

Background

Nonpulsatile perfusion during cardiopulmonary bypass can induce renal damage. We evaluated whether pulsatile perfusion using an intra-aortic balloon pump preserves renal function in patients undergoing myocardial revascularization.

Study Design

Randomized controlled trial, nonmasked parallel-group design.

Setting & Participants

100 patients undergoing preoperative perfusion using an intra-aortic balloon pump; 64 with baseline estimated glomerular filtration rate (eGFR) of 60 mL/min/1.73 m2 or greater (≥1 mL/s/1.73 m2; stage 1 or 2) and 36 with eGFR of 30 to 59 mL/min/1.73 m2 (0.5 to 0.98 mL/s/1.73 m2; stage 3).

Intervention

Patients were randomly assigned to nonpulsatile perfusion during cardiopulmonary bypass (group A) or automatic intra-aortic balloon pump–induced pulsatile perfusion during cardiopulmonary bypass (group B).

Outcomes & Measurements

Renal function, daily diuresis, complications, serum lactate levels, and other biochemical indices at 24 and 48 hours.

Results

GFR, adjusted for baseline eGFR, was 16 mL/min/1.73 m2 [0.27 mL/s/1.73 m2] less in group A (58.1 mL/min/1.73 m2; 95% confidence interval [CI], 56.1 to 60.1 mL/min/1.73 m2 [0.97 mL/s/1.73 m2; 95% CI, 0.94 to 1.0 mL/s/1.73 m2]) than in group B (74.0 mL/min/1.73 m2; 95% CI, 72.0 to 76.1 mL/min/1.73 m2 [1.23 mL/s/1.73 m2; 95% CI, 1.20 to 1.27 mL/s/1.73 m2]; P < 0.001). Plasma lactate levels were +3.9 mg/dL (+0.43 mmol/L) higher in group A (19.5 mg/dL; 95% CI, 18.4 to 20.5 mg/dL [2.16 mmol/L; 95% CI, 2.04 to 2.28 mmol/L]) than in group B (16.7 mg/dL; 95% CI, 14.4 to 16.7 mg/dL [1.73 mmol/L; 95% CI, 1.60 to 1.85 mmol/L]; P < 0.001). No significant difference between the 2 groups was observed for 24-hour diuresis. Patients with eGFR stage 3 had a greater decrease in GFR and daily diuresis and greater increase in lactate levels than those with eGFR stages 1 to 2.

Limitations

Short-term change in kidney function as a surrogate outcome for “hard” clinical outcomes of mortality, morbidity, and length of hospitalization. Other limitations are short-term follow-up and absence of measurement of hemodynamic parameters or inflammatory mediators.

Conclusions

Use of automatic pulsatile intra-aortic balloon pumps during cardiopulmonary bypass is associated with better renal function during myocardial reperfusion. More studies are needed to verify the effects of pulsatile intra-aortic balloon pumps.

Index Words: Renal function, cardiopulmonary bypass complications, pulsatile perfusion, renal dysfunction, renal hypoperfusion, hyperlactatemia

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 Trial registration: www.clinicaltrials.gov; study number: NCT00454428.

PII: S0272-6386(07)00843-8

doi:10.1053/j.ajkd.2007.05.017

American Journal of Kidney Diseases
Volume 50, Issue 2 , Pages 229-238, August 2007