Journal Home
Search for

Volume 50, Issue 2, Pages 229-238 (August 2007)


View previous. 16 of 34 View next.

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, MD1, Pierangela Presta, MD2, Giorgio Fuiano, MD2Corresponding Author Informationemail address, Pasquale Mastroroberto, MD1, Nicolino Comi, MD2, Francesco Pezzo, MD1, Carmela Tozzo, MD2, Attilio Renzulli, MD, PhD, FETCS1

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.

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

2 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.

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

PII: S0272-6386(07)00843-8

doi:10.1053/j.ajkd.2007.05.017


View previous. 16 of 34 View next.